Search

Your search keyword '"Maxime Coutrot"' showing total 36 results
Start Over Author "Maxime Coutrot"
36 results on '"Maxime Coutrot"'

1. Critically ill severe hypothyroidism: a retrospective multicenter cohort study

Author

Simon Bourcier, Maxime Coutrot, Alexis Ferré, Nicolas Van Grunderbeeck, Julien Charpentier, Sami Hraiech, Elie Azoulay, Saad Nseir, Nadia Aissaoui, Jonathan Messika, Pierre Fillatre, Romain Persichini, Serge Carreira, Alexandre Lautrette, Clément Delmas, Nicolas Terzi, Bruno Mégarbane, Jean-Baptiste Lascarrou, Keyvan Razazi, Xavier Repessé, Claire Pichereau, Damien Contou, Aurélien Frérou, François Barbier, Stephan Ehrmann, Etienne de Montmollin, Benjamin Sztrymf, Elise Morawiec, Naïke Bigé, Danielle Reuter, David Schnell, Olivier Ellrodt, Jean Dellamonica, Alain Combes, and Matthieu Schmidt

Subjects
Hypothyroidism, Myxedema, Coma, Cardiogenic shock, Critical care, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Severe hypothyroidism (SH) is a rare but life-threatening endocrine emergency. Only a few data are available on its management and outcomes of the most severe forms requiring ICU admission. We aimed to describe the clinical manifestations, management, and in-ICU and 6-month survival rates of these patients. Methods We conducted a retrospective, multicenter study over 18 years in 32 French ICUs. The local medical records of patients from each participating ICU were screened using the International Classification of Disease 10th revision. Inclusion criteria were the presence of biological hypothyroidism associated with at least one cardinal sign among alteration of consciousness, hypothermia and circulatory failure, and at least one SH-related organ failure. Results Eighty-two patients were included in the study. Thyroiditis and thyroidectomy represented the main SH etiologies (29% and 19%, respectively), while hypothyroidism was unknown in 44 patients (54%) before ICU admission. The most frequent SH triggers were levothyroxine discontinuation (28%), sepsis (15%), and amiodarone-related hypothyroidism (11%). Clinical presentations included hypothermia (66%), hemodynamic failure (57%), and coma (52%). In-ICU and 6-month mortality rates were 26% and 39%, respectively. Multivariable analyses retained age > 70 years [odds ratio OR 6.01 (1.75–24.1)] Sequential Organ-Failure Assessment score cardiovascular component ≥ 2 [OR 11.1 (2.47–84.2)] and ventilation component ≥ 2 [OR 4.52 (1.27–18.6)] as being independently associated with in-ICU mortality. Conclusions SH is a rare life-threatening emergency with various clinical presentations. Hemodynamic and respiratory failures are strongly associated with worse outcomes. The very high mortality prompts early diagnosis and rapid levothyroxine administration with close cardiac and hemodynamic monitoring.

Published
2023
Full Text
View/download PDF

2. Capillary refill time for the management of acute circulatory failure: a survey among pediatric and adult intensivists

Author

Matthias Jacquet-Lagrèze, Cléo Wiart, Rémi Schweizer, Léa Didier, Martin Ruste, Maxime Coutrot, Matthieu Legrand, Florent Baudin, Etienne Javouhey, François Dépret, and Jean-Luc Fellahi

Subjects
Capillary refill time, Acute circulatory failure, Survey, Peripheral perfusion, Shock, Special situations and conditions, RC952-1245, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Introduction Recent studies have shown the prognostic value of capillary refill time (CRT) and suggested that resuscitation management guided by CRT may reduce morbidity and mortality in patients with septic shock. However, little is known about the current use of CRT in routine clinical practice. This study aimed to assess the modalities of CRT use among French adult and pediatric intensivists. Methods A cross-sectional survey exploring CRT practices in acute circulatory failure was performed. The targeted population was French adult and pediatric intensivists (SFAR and GFRUP networks). An individual invitation letter including a survey of 32 questions was emailed twice. Descriptive and analytical statistics were performed. Results Among the 6071 physicians who received the letter, 418 (7%) completed the survey. Among all respondents, 82% reported using CRT in routine clinical practice, mainly to diagnose acute circulatory failure, but 45% did not think CRT had any prognostic value. Perfusion goal-directed therapy based on CRT was viewed as likely to improve patient outcome by 37% of respondents. The measurement of CRT was not standardized as the use of a chronometer was rare (3%) and the average of multiple measurements rarely performed (46%). Compared to adult intensivists, pediatric intensivists used CRT more frequently (99% versus 76%) and were more confident in its diagnostic value and its ability to guide treatment. Conclusion CRT measurement is widely used by intensivists in patients with acute circulatory failure but most often in a non-standardized way. This may lead to a misunderstanding of CRT reliability and clinical usefulness.

Published
2022
Full Text
View/download PDF

3. Circulating dipeptidyl peptidase-3 at admission is associated with circulatory failure, acute kidney injury and death in severely ill burn patients

Author

François Dépret, Juliette Amzallag, Adrien Pollina, Laure Fayolle-Pivot, Maxime Coutrot, Maïté Chaussard, Karine Santos, Oliver Hartmann, Marion Jully, Alexandre Fratani, Haikel Oueslati, Alexandru Cupaciu, Mourad Benyamina, Lucie Guillemet, Benjamin Deniau, Alexandre Mebazaa, Etienne Gayat, Boris Farny, Julien Textoris, Matthieu Legrand, and for the PRONOBURN group

Subjects
Dipeptidyl peptidase-3, Burn patients, Mortality, Acute kidney injury, Biomarkers, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Dipeptidyl peptidase-3 (DPP3) is a metallopeptidase which cleaves bioactive peptides, notably angiotensin II, and is involved in inflammation regulation. DPP3 has been proposed to be a myocardial depressant factor and to be involved in circulatory failure in acute illnesses, possibly due to angiotensin II cleavage. In this study, we evaluated the association between plasmatic DPP3 level and outcome (mortality and hemodynamic failure) in severely ill burn patients. Methods In this biomarker analysis of a prospective cohort study, we included severely ill adult burn patients in two tertiary burn intensive care units. DPP3 was measured at admission (DPP3admin) and 3 days after. The primary endpoint was 90-day mortality. Secondary endpoints were hemodynamic failure and acute kidney injury (AKI). Results One hundred and eleven consecutive patients were enrolled. The median age was 48 (32.5–63) years, with a median total body surface area burned of 35% (25–53.5) and Abbreviated Burn Severity Index (ABSI) of 8 (7–11). Ninety-day mortality was 32%. The median DPP3admin was significantly higher in non-survivors versus survivors (53.3 ng/mL [IQR 28.8–103.5] versus 27.1 ng/mL [IQR 19.4–38.9]; p

Published
2020
Full Text
View/download PDF

4. Acute Kidney Injury Induces Remote Cardiac Damage and Dysfunction Through the Galectin-3 Pathway

Author

Mathilde Prud’homme, PhD, Maxime Coutrot, MD, MSc, Thibault Michel, MD, MSc, Louis Boutin, MD, MSc, Magali Genest, PhD, Françoise Poirier, PhD, Jean-Marie Launay, PharmD, PhD, Bocar Kane, Satoshi Kinugasa, MD, PhD, Niki Prakoura, PhD, Sophie Vandermeersch, Alain Cohen-Solal, MD, PhD, Claude Delcayre, PhD, Jane-Lise Samuel, MD, PhD, Ravindra Mehta, MD, Etienne Gayat, MD, PhD, Alexandre Mebazaa, MD, PhD, Christos E. Chadjichristos, PhD, and Matthieu Legrand, MD, PhD

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Summary: Acute kidney injury is associated with increased risk of heart failure and mortality. This study demonstrates that acute kidney injury induces remote cardiac dysfunction, damage, injury, and fibrosis via a galectin-3 (Gal-3) dependent pathway. Gal-3 originates from bone marrow-derived immune cells. Cardiac damage could be prevented by blocking this pathway. Key Words: fibrosis, heart failure, inflammation, macrophages, renal failure

Published
2019
Full Text
View/download PDF

5. Characteristics and prognosis of Herpesviridae-related pneumonia in critically ill burn patients

Author

Charline Riaud, Alexandre Fratani, Kevin Serror, Maïté Chaussard, Matthieu Lafaurie, Haikel Oueslati, Alexandru Cupaciu, Lucie Guillemet, Maxime Coutrot, François Dépret, Jil Rouaux, Maud Salmona, Marc Chaouat, Matthieu Legrand, Jérôme LeGoff, Mourad Benyamina, and Alexandre Mebazaa

Subjects
medicine.medical_specialty, Critical Illness, Smoke inhalation, Critical Care and Intensive Care Medicine, law.invention, Cohort Studies, law, Smoke, Internal medicine, medicine, Humans, Herpesviridae, Retrospective Studies, medicine.diagnostic_test, business.industry, Ventilator-associated pneumonia, Pneumonia, General Medicine, Middle Aged, Smoke Inhalation Injury, Prognosis, medicine.disease, Intensive care unit, Intensive Care Units, Bronchoalveolar lavage, Emergency Medicine, Surgery, SOFA score, Burns, business, Total body surface area, Cohort study
Abstract

The aim of this study was to describe the prevalence, characteristics and outcome of critically burn patients with pulmonary HSV reactivation.Retrospective, single-center cohort study in a burn critical care unit in a tertiary center, including all consecutive severely burn patients with bronchoalveolar lavage performed for pneumoniae suspicion and screened for HSV from January 2013 and April 2017. We used logistic regression to identify factors associated with HSV reactivation and outcomes.94 patients were included, mean age was 51 (39-64) years; median total body surface area burned was 36 (25-54)% and ICU mortality 38%. Fifty-five patients (59%) had pulmonary HSV reactivation and 30 (55%) were treated with acyclovir. Patients with HSV reactivation were more severely ill with higher SOFA score at admission compared to patient without HSV reactivation (6 [3-8] vs. 2 [1-4], p0.0001 respectively). In multivariate analysis, sex, SOFA score at admission and smoke inhalation were significantly associated with HSV reactivation. Only septic shock was associated with 90-day mortality when HSV reactivation was not.Pulmonary HSV reactivation is frequent among severely ill burn patients. Initial severity and smoke inhalation are risk factors. Antiviral treatment was not associated with outcome.

Published
2022
Full Text
View/download PDF

7. Prospective multi-centre evaluation of the incidence of unplanned extubation and its outcomes in intensive care units. The Safe-ICU study

Author

Jérémie Guillemin, Benjamin Rieu, Olivier Huet, Léonie Villeret, Stéphanie Pons, Anne Bignon, Quentin De Roux, Raphaël Cinotti, Vincent Legros, Gaëtan Plantefeve, Claire Dayhot-Fizelier, Edris Omar, Cyril Cadoz, Fanny Bounes, Cécile Caplin, Karim Toumert, Thibault Martinez, Damien Bouvier, Maxime Coutrot, Thomas Godet, Pierre Garçon, Mona Assefi, and Jean-Michel Constantin

Abstract

Background: The lack of a clear definition and strong methodology has led to differing results in terms of unplanned extubation (UE) epidemiology and outcomes. We aimed to determine the UE incidence and clinical significance of both accidental extubation and self-extubation. Methods: A multicentric prospective cohort study was conducted in 47 French ICUs. The number of mechanical ventilation (MV) days, planned and unplanned extubation were recorded in each centre over a minimum period of three consecutive months to evaluate UE incidence. Patient characteristics, UE environmental factors, and outcomes (follow-up until ICU discharge or day 28) were compared based on the UE mechanism (accidental or self-extubation). Finally, we determined ‘failed’ self-extubation (re-intubation at day 7) prognosis and risk factors. Results: During the 12-month inclusion period, we found a pooled UE incidence of 1.0 per 100 MV days. UE accounted for 9% of all endotracheal removals. Of the 635 UE, 88% were self-extubations and 12% were accidental extubations. The latter had a worse prognosis than self-extubations (34% vs 14% mortality, p 2/FiO2, weaning process not ongoing, and immediate post-extubation respiratory failure were independent predictors of failed self-extubation. Discomfort was the leading cause of self-extubation reported by both patients and physicians, ahead of agitation. Conclusion: Unplanned extubation is common in ICU and accounts for 9% of all endotracheal removals. Accidental extubation has a poorer prognosis than self-extubation.

Published
2023
Full Text
View/download PDF

8. Multiplex bacterial PCR for antibiotic stewardship in pneumonia

Author

Emmanuel Dudoignon, Maxime Coutrot, François Camelena, Marc Leone, and François Dépret

Subjects
Pulmonary and Respiratory Medicine, Community-Acquired Infections, Antimicrobial Stewardship, Humans, Pneumonia, Multiplex Polymerase Chain Reaction, Anti-Bacterial Agents
Published
2022

9. Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis

Author

David Hajage, Alain Combes, Christophe Guervilly, Guillaume Lebreton, Alain Mercat, Arthur Pavot, Saad Nseir, Armand Mekontso-Dessap, Nicolas Mongardon, Jean Paul Mira, Jean-Damien Ricard, Alexandra Beurton, Guillaume Tachon, Loay Kontar, Christophe Le Terrier, Jean Christophe Richard, Bruno Mégarbane, Ruth H. Keogh, Aurélien Belot, Camille Maringe, Clémence Leyrat, Matthieu Schmidt, Pierre Asfar, François Beloncle, Julien Demiselle, Tài Pham, Xavier Monnet, Christian Richard, Alexandre Demoule, Martin Dres, Julien Mayaux, Cédric Daubin, Richard Descamps, Aurélie Joret, Damien Du Cheyron, Frédéric Pene, Jean-Daniel Chiche, Mathieu Jozwiak, Paul Jaubert, Guillaume Voiriot, Muriel Fartoukh, Marion Teulier, Clarisse Blayau, Erwen L'Her, Cécile Aubron, Laetitia Bodenes, Nicolas Ferriere, Johann Auchabie, Anthony Le Meur, Sylvain Pignal, Thierry Mazzoni, Jean-Pierre Quenot, Pascal Andreu, Jean-Baptiste Roudau, Marie Labruyère, Sébastien Preau, Julien Poissy, Daniel Mathieu, Sarah Benhamida, Rémi Paulet, Nicolas Roucaud, Martial Thyrault, Florence Daviet, Sami Hraiech, Gabriel Parzy, Aude Sylvestre, Sébastien Jochmans, Anne-Laure Bouilland, Mehran Monchi, Marc Danguy des Déserts, Quentin Mathais, Gwendoline Rager, Pierre Pasquier, Jean Reignier, Amélie Seguin, Charlotte Garret, Emmanuel Canet, Jean Dellamonica, Clément Saccheri, Romain Lombardi, Yanis Kouchit, Sophie Jacquier, Armelle Mathonnet, Mai-Ahn Nay, Isabelle Runge, Frédéric Martino, Laure Flurin, Amélie Rolle, Michel Carles, Rémi Coudroy, Arnaud W. Thille, Jean-Pierre Frat, Maeva Rodriguez, Pascal Beuret, Audrey Tientcheu, Arthur Vincent, Florian Michelin, Fabienne Tamion, Dorothée Carpentier, Déborah Boyer, Gaetan Beduneau, Valérie Gissot, Stéphan Ehrmann, Charlotte Salmon Gandonniere, Djlali Elaroussi, Agathe Delbove, Yannick Fedun, Julien Huntzinger, Eddy Lebas, Grâce Kisoka, Céline Grégoire, Stella Marchetta, Bernard Lambermont, Laurent Argaud, Thomas Baudry, Pierre-Jean Bertrand, Auguste Dargent, Christophe Guitton, Nicolas Chudeau, Mickaël Landais, Cédric Darreau, Alexis Ferre, Antoine Gros, Guillaume Lacave, Fabrice Bruneel, Mathilde Neuville, Jérôme Devaquet, Richard Gallot, Riad Chelha, Arnaud Galbois, Anne Jallot, Ludivine Chalumeau Lemoine, Khaldoun Kuteifan, Valentin Pointurier, Louise-Marie Jandeaux, Joy Mootien, Charles Damoisel, Benjamin Sztrymf, Juliette Chommeloux, Charles Edouard Luyt, Frédérique Schortgen, Leon Rusel, Camille Jung, Florent Gobert, Damien Vimpere, Lionel Lamhaut, Bertrand Sauneuf, Liliane Charrrier, Julien Calus, Isabelle Desmeules, Benoît Painvin, Jean-Marc Tadie, Vincent Castelain, Baptiste Michard, Jean-Etienne Herbrecht, Mathieu Baldacini, Nicolas Weiss, Sophie Demeret, Clémence Marois, Benjamin Rohaut, Pierre-Henri Moury, Anne-Charlotte Savida, Emmanuel Couadau, Mathieu Série, Nica Alexandru, Cédric Bruel, Candice Fontaine, Sonia Garrigou, Juliette Courtiade Mahler, Maxime Leclerc, Michel Ramakers, Pierre Garçon, Nicole Massou, Ly Van Vong, Juliane Sen, Nolwenn Lucas, Franck Chemouni, Annabelle Stoclin, Alexandre Avenel, Henri Faure, Angélie Gentilhomme, Sylvie Ricome, Paul Abraham, Céline Monard, Julien Textoris, Thomas Rimmele, Florent Montini, Gabriel Lejour, Thierry Lazard, Isabelle Etienney, Younes Kerroumi, Claire Dupuis, Marine Bereiziat, Elisabeth Coupez, François Thouy, Clément Hoffmann, Nicolas Donat, Anne Chrisment, Rose-Marie Blot, Antoine Kimmoun, Audrey Jacquot, Matthieu Mattei, Bruno Levy, Ramin Ravan, Loïc Dopeux, Jean-Mathias Liteaudon, Delphine Roux, Brice Rey, Radu Anghel, Deborah Schenesse, Vincent Gevrey, Jermy Castanera, Philippe Petua, Benjamin Madeux, Otto Hartman, Michael Piagnerelli, Anne Joosten, Cinderella Noel, Patrick Biston, Thibaut Noel, Gurvan LE Bouar, Messabi Boukhanza, Elsa Demarest, Marie-France Bajolet, Nathanaël Charrier, Audrey Quenet, Cécile Zylberfajn, Nicolas Dufour, Buno Mégarbane, Sébastian Voicu, Nicolas Deye, Isabelle Malissin, François Legay, Matthieu Debarre, Nicolas Barbarot, Pierre Fillatre, Bertrand Delord, Thomas Laterrade, Tahar Saghi, Wilfried Pujol, Pierre Julien Cungi, Pierre Esnault, Mickael Cardinale, Vivien Hong Tuan Ha, Grégory Fleury, Marie-Ange Brou, Daniel Zafimahazo, David Tran-Van, Patrick Avargues, Lisa Carenco, Nicolas Robin, Alexandre Ouali, Lucie Houdou, Noémie Suh, Steve Primmaz, Jérome Pugin, Emmanuel Weiss, Tobias Gauss, Jean-Denis Moyer, Catherine Paugam Burtz, Béatrice La Combe, Rolland Smonig, Jade Violleau, Pauline Cailliez, Jonathan Chelly, Antoine Marchalot, Cécile Saladin, Christelle Bigot, Pierre-Marie Fayolle, Jules Fatséas, Amr Ibrahim, Dabor Resiere, Rabih Hage, Clémentine Cholet, Marie Cantier, Pierre Trouiler, Philippe Montravers, Brice Lortat-Jacob, Sebastien Tanaka, Alexy Tran Dinh, Jacques Duranteau, Anatole Harrois, Guillaume Dubreuil, Marie Werner, Anne Godier, Sophie Hamada, Diane Zlotnik, Hélène Nougue, Guillaume Carteaux, Keyvan Razazi, Nicolas De Prost, Meriam Lamraoui, Claire Alessandri, Quentin de Roux, Charles de Roquetaillade, Benjamin G. Chousterman, Alexandre Mebazaa, Etienne Gayat, Marc Garnier, Emmanuel Pardo, Lea Satre-Buisson, Christophe Gutton, Elise Yvin, Clémence Marcault, Elie Azoulay, Michael Darmon, Hafid Ait Oufella, Geoffroy Hariri, Tomas Urbina, Sandie Mazerand, Nicholas Heming, Francesca Santi, Pierre Moine, Djillali Annane, Adrien Bouglé, Edris Omar, Aymeric Lancelot, Emmanuelle Begot, Gaétan Plantefeve, Damien Contou, Hervé Mentec, Olivier Pajot, Stanislas Faguer, Olivier Cointault, Laurence Lavayssiere, Marie-Béatrice Nogier, Matthieu Jamme, Claire Pichereau, Jan Hayon, Hervé Outin, François Dépret, Maxime Coutrot, Maité Chaussard, Lucie Guillemet, Pierre Goffin, Romain Thouny, Julien Guntz, Laurent Jadot, Romain Persichini, Vanessa Jean-Michel, Hugues Georges, Thomas Caulier, Gaël Pradel, Marie-Hélène Hausermann, Thi My Hue Nguyen-Valat, Michel Boudinaud, Emmanuel Vivier, Sylvène Rosseli, Gaël Bourdin, Christian Pommier, Marc Vinclair, Simon Poignant, Sandrine Mons, Wulfran Bougouin, Franklin Bruna, Quentin Maestraggi, Christian Roth, Laurent Bitker, François Dhelft, Justine Bonnet-Chateau, Mathilde Filippelli, Tristan Morichau-Beauchant, Stéphane Thierry, Charlotte Le Roy, Mélanie Saint Jouan, Bruno Goncalves, Aurélien Mazeraud, Matthieu Daniel, Tarek Sharshar, Cyril Cadoz, Rostane Gaci, Sébastien Gette, Guillaune Louis, Sophe-Caroline Sacleux, Marie-Amélie Ordan, Aurélie Cravoisy, Marie Conrad, Guilhem Courte, Sébastien Gibot, Younès Benzidi, Claudia Casella, Laurent Serpin, Jean-Lou Setti, Marie-Catherine Besse, Anna Bourreau, Jérôme Pillot, Caroline Rivera, Camille Vinclair, Marie-Aline Robaux, Chloé Achino, Marie-Charlotte Delignette, Tessa Mazard, Frédéric Aubrun, Bruno Bouchet, Aurélien Frérou, Laura Muller, Charlotte Quentin, Samuel Degoul, Xavier Stihle, Claude Sumian, Nicoletta Bergero, Bernard Lanaspre, Hervé Quintard, Eve Marie Maiziere, Pierre-Yves Egreteau, Guillaume Leloup, Florin Berteau, Marjolaine Cottrel, Marie Bouteloup, Matthieu Jeannot, Quentin Blanc, Julien Saison, Isabelle Geneau, Romaric Grenot, Abdel Ouchike, Pascal Hazera, Anne-Lyse Masse, Suela Demiri, Corinne Vezinet, Elodie Baron, Deborah Benchetrit, Antoine Monsel, Grégoire Trebbia, Emmanuelle Schaack, Raphaël Lepecq, Mathieu Bobet, Christophe Vinsonneau, Thibault Dekeyser, Quentin Delforge, Imen Rahmani, Bérengère Vivet, Jonathan Paillot, Lucie Hierle, Claire Chaignat, Sarah Valette, Benoït Her, Jennifier Brunet, Mathieu Page, Fabienne Boiste, Anthony Collin, Florent Bavozet, Aude Garin, Mohamed Dlala, Kais Mhamdi, Bassem Beilouny, Alexandra Lavalard, Severine Perez, Benoit Veber, Pierre-Gildas Guitard, Philippe Gouin, Anna Lamacz, Fabienne Plouvier, Bertrand P Delaborde, Aïssa Kherchache, Amina Chaalal, Marc Amouretti, Santiago Freita-Ramos, Damien Roux, Jean-Michel Constantin, Mona Assefi, Marine Lecore, Agathe Selves, Florian Prevost, Christian Lamer, Ruiying Shi, Lyes Knani, Sébastien Pili Floury, Lucie Vettoretti, Michael Levy, Lucile Marsac, Stéphane Dauger, Sophie Guilmin-Crépon, Hadrien Winiszewski, Gael Piton, Thibaud Soumagne, Gilles Capellier, Jean-Baptiste Putegnat, Frédérique Bayle, Maya Perrou, Ghyslaine Thao, Guillaume Géri, Cyril Charron, Xavier Repessé, Antoine Vieillard-Baron, Mathieu Guilbart, Pierre-Alexandre Roger, Sébastien Hinard, Pierre-Yves Macq, Kevin Chaulier, Sylvie Goutte, Patrick Chillet, Anaïs Pitta, Barbara Darjent, Amandine Bruneau, Sigismond Lasocki, Maxime Leger, Soizic Gergaud, Pierre Lemarie, Nicolas Terzi, Carole Schwebel, Anaïs Dartevel, Louis-Marie Galerneau, Jean-Luc Diehl, Caroline Hauw-Berlemont, Nicolas Péron, Emmanuel Guérot, Abolfazl Mohebbi Amoli, Michel Benhamou, Jean-Pierre Deyme, Olivier Andremont, Diane Lena, Julien Cady, Arnaud Causeret, Arnaud De La Chapelle, Christophe Cracco, Stéphane Rouleau, David Schnell, Camille Foucault, Cécile Lory, Thibault Chapelle, Vincent Bruckert, Julie Garcia, Abdlazize Sahraoui, Nathalie Abbosh, Caroline Bornstain, Pierre Pernet, Florent Poirson, Ahmed Pasem, Philippe Karoubi, Virginie Poupinel, Caroline Gauthier, François Bouniol, Philippe Feuchere, Anne Heron, Serge Carreira, Malo Emery, Anne Sophie Le Floch, Luana Giovannangeli, Nicolas Herzog, Christophe Giacardi, Thibaut Baudic, Chloé Thill, Said Lebbah, Jessica Palmyre, Florence Tubach, Nicolas Bonnet, Nathan Ebstein, Stéphane Gaudry, Yves Cohen, Julie Noublanche, Olivier Lesieur, Arnaud Sément, Isabel Roca-Cerezo, Michel Pascal, Nesrine Sma, Gwenhaël Colin, Jean-Claude Lacherade, Gauthier Bionz, Natacha Maquigneau, Pierre Bouzat, Michel Durand, Marie-Christine Hérault, Jean-Francois Payen, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Nord [CHU - APHM], Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université (AMU), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Université Paris-Saclay, CHU Lille, Hôpital Henri Mondor, Groupe de recherche clinique CARMAS [Créteil] (UPEC/Faculté de Médecine de Créteil), 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), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Descartes - Paris 5 (UPD5), Hôpital Louis Mourier - AP-HP [Colombes], Hôpital Foch [Suresnes], CHU Amiens-Picardie, Geneva University Hospital (HUG), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpital Lariboisière-Fernand-Widal [APHP], London School of Hygiene and Tropical Medicine (LSHTM), RICHARD, Jean-Christophe, Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Pulmonary and Respiratory Medicine, Adult, Respiratory Distress Syndrome, SARS-CoV-2, [SDV]Life Sciences [q-bio], acute respiratory distress syndrome (ARDS), COVID-19, extracorporeal membrane oxygenation, Critical Care and Intensive Care Medicine, Cohort Studies, [SDV] Life Sciences [q-bio], emulated target trial, acute respiratory distress syndrome, Treatment Outcome, surgical procedures, operative, Humans, Retrospective Studies
Abstract

International audience; Rationale: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown.Objectives: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2

Published
2022
Full Text
View/download PDF

10. Early hypoalbuminemia is associated with 28-day mortality in severely burned patients: A retrospective cohort study

Author

Maurice Mimoun, Maïté Chaussard, Alexandre Fratani, Christian de Tymowski, Haikel Oueslati, Alexandru Cupaciu, James Anstey, Lucie Guillemet, Mourad Benyamina, Alexandre Mebazaa, Matthieu Legrand, Simon Pallado, Nabilla Moreno, Maxime Coutrot, Marion Jully, Sabri Soussi, M. Chaouat, Emmanuel Dudoignon, and François Dépret

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, Burn Units, Context (language use), Critical Care and Intensive Care Medicine, Post injury, Gastroenterology, Capillary Permeability, Cohort Studies, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Albumins, Sepsis, Internal medicine, medicine, Humans, Severe burn, Hypoalbuminemia, Mortality, Serum Albumin, Aged, Retrospective Studies, Respiratory Distress Syndrome, Trauma Severity Indices, business.industry, Albumin, 030208 emergency & critical care medicine, Retrospective cohort study, Crystalloid Solutions, General Medicine, Acute Kidney Injury, Length of Stay, Middle Aged, Prognosis, medicine.disease, Respiration, Artificial, Renal Replacement Therapy, Emergency Medicine, Fluid Therapy, Female, Surgery, Burns, 28 day mortality, Multiple organ dysfunction syndrome, business
Abstract

Hypoalbuminemia is a frequent condition in the first 24 h after a severe burn injury and is associated with worse outcomes.We investigated the relation between very early hypoalbuminemia (6 h after admission) and clinical outcome in a retrospective cohort admitted to our unit for severe burn injuries between 2012 and 2017.73 severely burned patients were included, with a delay of admission of 3 (2-4) h. In a context of early exogenous supply of albumin, admission and 4H Albuminemia (Alb4 h) were significantly lower in deceased patients (respectively, 34 (29-37) vs 27 (23-30) g/l; p = 0.009 and 27 (24-32) vs 21 (17-27) g/l; p = 0.022) whereas albuminemia ≥6 h were not. The best threshold value of Alb4 h to discriminate 28-day mortality was 23 g/l. Patients with an Alb4 h 23 g/l had a higher 28-day mortality than patients with an Alb4 h ≥ 23 g/l (42% vs 11%; p = 0.003); adjusted OR = 4.47 (95% CI 1.15-17.36); p = 0.03.In severely burned patients receiving early albumin supply, early hypoalbuminemia is associated with higher mortality whereas later albuminemia (≥6 h) is not. Exploration of whether early albumin infusion (8-12 h post injury) may alter clinical outcome is warranted.

Published
2020
Full Text
View/download PDF

11. Physiological response to fluid resuscitation with Ringer lactate versus Plasmalyte in critically ill burn patients

Author

Pascal Houzé, Marion Jully, Haikel Oueslati, François Dépret, Oriane Saint-Aubin, Alicia Poniard, Mourad Benyamina, Maxime Coutrot, Alexandru Cupaciu, Maïté Chaussard, Alexandre Mebazaa, Alexandre Fratani, Karim Asehnoune, Solohaja-Faniaha Dimby, and Matthieu Legrand

Subjects
Resuscitation, Ringer's Lactate, Physiology, Critical Illness, Hemodynamics, Gluconates, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Physiology (medical), Humans, Medicine, Lactic Acid, Calcium metabolism, business.industry, Critically ill, 030208 emergency & critical care medicine, Metabolism, Confidence interval, Anesthesia, Base excess, Isotonic Solutions, Burns, business, Total body surface area
Abstract

The metabolic consequences in vivo of various balanced solutions are poorly known in critically ill patients. The main objective of this study was to describe the metabolic consequences of Plasmalyte versus Ringer lactate (RL) in critically ill burn patients, with a special focus on the plasma clearance of buffer anions (i.e., gluconate, acetate, and lactate). We conducted a randomized trial between August 2017 and October 2018 in a tertiary teaching hospital in Paris, France. Patients with burn total body surface area >30% were randomized to receive Plasmalyte or RL. The primary end point was the base excess 24 h after inclusion. The secondary end points were acetate, gluconate, and lactate plasma concentration, the strong ion difference (SID). Twenty-eight patients were randomized. Twenty-four hours after inclusion, plasma BE was not significantly different in the Plasmalyte and RL groups {−0.9 [95% confidence interval (95% CI): −1.8–0.9] vs. −2.1 [95% CI: −4.6–0.6] mmol/L, respectively, P = 0.26}. Plasma gluconate concentration was higher in the Plasmalyte group ( P < 0.001), with a maximum level of 1.86 (95% CI: 0.98–4.0) mmol/L versus 0 (95% CI: 0–0.15) mmol/L. Plasma acetate and lactate were not significantly different. Ionized calcium level was lower in the Plasmalyte group ( P = 0.002). Hemodynamics did not differ between groups. To conclude, the alkalinizing effect of Plasmalyte was less important than expected with no difference in base excess compared with RL, in part due to gluconate accumulation. Acetate and lactate did not significantly accumulate. Plasmalyte led to significantly lower ionized calcium levels. NEW & NOTEWORTHY During fluid resuscitation in burns the alkalinizing effect of Plasmalyte was less important than expected, with no difference in base excess compared with Ringer lactate (RL), in part due to gluconate accumulation. Acetate and lactate did not significantly accumulate. Plasmalyte led to significantly lower ionized calcium levels.

Published
2020
Full Text
View/download PDF

12. Real-time estimation of mean arterial blood pressure based on photoplethysmography dicrotic notch and perfusion index. A pilot study

Author

Sandrine Millasseau, Fabrice Vallée, Jona Joachim, Joaquim Mateo, Etienne Gayat, Alexandre Mebazaa, and Maxime Coutrot

Subjects
Mean arterial pressure, Continuous monitoring, Beat (acoustics), 030208 emergency & critical care medicine, Health Informatics, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, Amplitude, Blood pressure, Mean blood pressure, 030202 anesthesiology, Photoplethysmogram, Cuff, Biomedical engineering, Mathematics
Abstract

Hypotension during general anesthesia is associated with poor outcome. Continuous monitoring of mean blood pressure (MAP) during anesthesia is useful and needs to be reliable and minimally invasive. Conventional cuff measurements can lead to delays due to its discontinuous nature. It has been shown that there is a relationship between MAP and photoplethysmography (PPG) parameters like the dicrotic notch and perfusion index (PI). The objective of the study was to continuously estimate MAP from PPG. Pulse wave analysis based on PPG was implemented using either notch relative amplitude (MAPNRA), notch absolute amplitude (MAPNAA) or PI (MAPPI) to estimate MAP from PPG waveform features during general anesthesia. Estimated MAP values were compared to brachial cuff MAP (MAPcuff) and to radial invasive MAP (MAPinv). Forty-six patients were analyzed for a total of 235 h. Compared to MAPcuff, mean bias and limits of agreement were 1 mmHg (− 26 to +29), − 1 mmHg (− 10 to +8) and − 3 mmHg (− 21 to +13) for MAPNRA, MAPNAA and MAPPI respectively. Compared to MAPinv, mean absolute error (MAE) was 20 mmHg [10 to 39], 11 mmHg [5 to 18] and 16 mmHg [9 to 24] for MAP derived from MAPNRA, MAPNAA and MAPPI respectively. When calibrated every 5 min, MAPNAA showed a MAE of 6 mmHg [5 to 9]. MAPNAA provides the best estimates with respect to brachial cuff MAP and invasive MAP. Regular calibration allows to reduce drift over time. Beat to beat estimation of MAP during general anesthesia from the PPG appears possible with an acceptable average error.

Published
2020
Full Text
View/download PDF

13. Prevalence, Intensity, and Clinical Impact of Dyspnea in Critically Ill Patients Receiving Invasive Ventilation

Author

Alexandre Demoule, David Hajage, Jonathan Messika, Samir Jaber, Hassimiou Diallo, Maxime Coutrot, Achille Kouatchet, Elie Azoulay, Muriel Fartoukh, Sami Hraiech, Pascal Beuret, Michael Darmon, Maxens Decavèle, Jean-Damien Ricard, Gerald Chanques, Alain Mercat, Matthieu Schmidt, Thomas Similowski, Morgane Faure, Suela Demiri, Marie-Amelie Ordan, Maxime Mallet, Guillaume Berquier, Béatrice La Combe, Malo Emery, Abirami Thiagarajah, Fouad Belafia, Mathieu Capdevila, Yassir Aarab, Alain Combes, Guillaume Hekimian, Loic Le Gunnec, Cherifa Gouanne, Clementine Taconet, Laurent Papazian, Jean-Marie Forel, Christophe Guervilly, Mélanie Adda, Xavier Fabre, Jean-Charles Chakarian, Bénédicte Philippon-Jouve, Florian Michelin, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Réanimation Médicale et de Médecine Hyperbare [Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Hopital Saint-Louis [AP-HP] (AP-HP), CHU Tenon [AP-HP], 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], Centre Hospitalier de Roanne, Département d'anesthésie-réanimation[Montpellier], and Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [CHU Montpellier]

Subjects
Pulmonary and Respiratory Medicine, acute respiratory failure, Noninvasive Ventilation, Critical Illness, Respiration, Critical Care and Intensive Care Medicine, Respiration, Artificial, Intensive Care Units, Mechanical ventilation, Dyspnea, Prevalence, post-traumatic stress disorder, Humans, Prospective Studies, intensive care unit burden, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; Background: Dyspnea is a traumatic experience. Only limited information is available on dyspnea in intubated critically ill patients. Our objectives were 1) To quantify the prevalence and severity of dyspnea, 2) To evaluate the impact of dyspnea on intensive care unit (ICU) length of stay and post-traumatic stress disorder (PTSD) 90 days after ICU discharge.Methods: Prospective cohort study in 10 ICUs in France. In patients intubated for more than 24 hours, dyspnea was quantified with a visual analog scale (from zero to 10) as soon as they were able to communicate, the following day and prior spontaneous breathing trials. PTSD was defined by an Impact of Event Scale-Revised score ≥ 22.Results: Among the 612 patients assessed, 34% reported dyspnea, with a median dyspnea rating of 5 (interquartile range, 4-7). ICU length of stay was not significantly different between dyspneic and non-dyspneic patients (6 [3-12] and 6 [3-13] days, respectively; P=0.781). Mortality was not different between groups. Of the 153 patients interviewed on day 90, a higher proportion of individuals with probable PTSD was observed among patients who were dyspneic on enrolment (29% vs. 13%, P=0.017). The density of dyspnea (number of dyspneic episodes divided by time from enrolment to extubation) were independently associated with post-traumatic stress disorder (odds ratio: 1.07, 95% confidence interval: 1.01-1.13, P=0.031).Conclusion: Dyspnea was frequent and intense in intubated critically ill patients. ICU length of stay was not significantly different among patients reporting dyspnea, but PTSD was more frequent at day 90.

Published
2022
Full Text
View/download PDF

14. Tailoring treatment of hyperkalemia

Author

François Dépret, Maxime Coutrot, and Matthieu Legrand

Subjects
Male, medicine.medical_specialty, Hyperkalemia, Water-Electrolyte Imbalance, Angiotensin-Converting Enzyme Inhibitors, Renin-Angiotensin System, Cardiac toxicity, Renin–angiotensin system, medicine, Humans, In patient, Intensive care medicine, Mineralocorticoid Receptor Antagonists, Transplantation, Kidney, business.industry, medicine.disease, medicine.anatomical_structure, Nephrology, Heart failure, Chronic Disease, Potassium, medicine.symptom, business, Serum potassium level, Electrolyte Disorder
Abstract

Hyperkalemia is a common electrolyte disorder that may be rapidly life-threatening because of its cardiac toxicity. Hyperkalemia risk factors are numerous and often combined in the same patient. Most of the strategies to control serum potassium level in the short term have been used for decades. However, evidence for their efficacy and safety remains low. Treatment of hyperkalemia remains challenging, poorly codified, with a risk of overtreatment, including short-term side effects, and with the priority of avoiding unnecessary hospital stays or chronic medication changes. Recently, new oral treatments have been proposed for non-life-threatening hyperkalemia, with encouraging results. Their role in the therapeutic arsenal remains uncertain. Finally, a growing body of evidence suggests that hyperkalemia might negatively impact outcomes in the long term in patients with chronic heart failure or kidney failure through underdosing or withholding of cardiovascular medication (e.g. renin–angiotensin–aldosterone system inhibitors). Recognition of efficacy and potential side effects of treatment may help in tailoring treatments to the patient’s status and conditions. In this review we discuss how treatment of hyperkalemia could be tailored to the patient’s conditions and status, both on the short and mid term.

Published
2019
Full Text
View/download PDF

15. Unexpected acute pulmonary embolism in an old COVID-19 patient with warfarin overdose: a case report

Author

Maxime Delrue, Virginie Siguret, Maxime Coutrot, and Bérangère S. Joly

Subjects
Pediatrics, medicine.medical_specialty, medicine.drug_class, Overdose, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Case report, medicine, AcademicSubjects/MED00200, 030212 general & internal medicine, business.industry, Pulmonary embolism, Anticoagulant, Warfarin, COVID-19, Atrial fibrillation, medicine.disease, Intensive care unit, Thrombosis, Respiratory failure, D-dimer, VKORC1, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract

Background Severe acute respiratory syndrome coronavirus 2 disease is strongly associated with a high incidence of thrombotic events. Anticoagulation could be a cornerstone in successfully managing severe forms of coronavirus disease 2019 (COVID-19). However, optimal anticoagulant dosing in elderly patients is challenging because of high risk of both thrombosis and bleeding. Case summary We present here the case of an 89-year-old patient receiving warfarin for atrial fibrillation and valvular heart disease, admitted to the intensive care unit for respiratory failure due to COVID-19. The patient presented with a severe epistaxis associated with warfarin overdose [international normalized ratio (INR) > 10]. After a successful initial reversal using vitamin K per os, INR values greatly fluctuated up to 10, requiring repeated administrations of vitamin K. Despite starting low-molecular-weight heparin therapy at therapeutic dose as soon as INR value was below 2.0, the patient further developed an acute bilateral and proximal pulmonary embolism concomitantly with a sharp D-dimer increase. The combination of azithromycin intake, a known inhibitor of CYP2C9, with the presence of CYP2C9*2 and −1639G>A VKORC1, two variants associated with warfarin hypersensitivity, have likely contributed to explain the warfarin overdose and the difficulty to reverse warfarin effect in this patient. Discussion This case report illustrates the complexity of COVID-19 pathophysiology and its management for physicians, especially in patients receiving vitamin K antagonists (VKAs). Infection, concurrent medication use, and pharmacogenetic factors involved in VKA metabolism and pharmacodynamics may lead to a loss of control of anticoagulation. Pulmonary embolism should still be considered in COVID-19 patients even with effective or overdosed anticoagulant therapy.

Published
2021
Full Text
View/download PDF

16. Usefulness of lactate albumin ratio at admission to predict 28-day mortality in critically ill severely burned patients: A retrospective cohort study

Author

Emmanuel Dudoignon, Thomas Quennesson, Christian De Tymowski, Nabila Moreno, Maxime Coutrot, Maïté Chaussard, Lucie Guillemet, Sonia Abid, Alexandre Fratani, Quentin Ressaire, Alexandru Cupaciu, Vagh Weinmann, Alexandre Pharaboz, Mourad Benyamina, Alexandre Mebazaa, Matthieu Legrand, François Depret, and Benjamin Deniau

Subjects
Male, Critical Illness, Albumins, Emergency Medicine, Humans, Surgery, General Medicine, Lactic Acid, Critical Care and Intensive Care Medicine, Burns, Prognosis, Retrospective Studies
Abstract

Lactate albumin ratio (LAR) has been used as a prognostic marker associated with organ failure in critically ill septic patients. LAR and its association with outcomes has never been studied in burned patients. The aim of this study was to evaluate the ability of LAR to predict 28-day mortality.A retrospective cohort study including all burn patients hospitalized in intensive care unit. The primary endpoint was the 28-day mortality.One thousand three hundred thirty four patients were screened, and 471 were included between June 2012 and December 2018. Briefly, the population study was mainly composed by men (249, 59.1%), the median age, TBSA burned, full thickness, ABSI and IGS2 were 52 [34-68], 20 [10-40], 8 [1-23], 7 [5-9] and 25 [15-40] respectively. Fifty-two patients (12.4%) died at day 28 after admission. At admission, the LAR level was lower in 28-day survivors compared non-survivors (0.05 [0.04, 0.08] vs 0.12 [0.07, 0.26], p 0.001 respectively). In multivariate analysis accounting for ABSI, LAR levels at admission 0.13 was independently associated with 28-day mortality (adjusted OR = 3.98 (IC95 1.88-8.35)). The ability of LAR at admission to discriminate 28-day mortality showed an AUC identical when compared to SOFA and ABSI scores (0.81 (IC95 0.74-0.88), 0.80 (IC95 0.72-0.85) and (0.85 (IC95 0.80-0.90), p 0.05, respectively). Patients with LAR levels ≥ 0.13 at admission had higher 28-day mortality (40.6% vs 6.8%, p 0.001, HR 7.39 (IC95 4.28-12.76)).At admission, LAR is an easy and reliable marker independently associated to 28-day mortality in patients with severe burn injury, but prediction by LAR does not perform better than lactate level alone.

Published
2021

17. Performance of a multiplex polymerase chain reaction panel for identifying bacterial pathogens causing pneumonia in critically ill patients with COVID-19

Author

Thibaut Poncin, Béatrice Berçot, Mourad Benyamina, Alexandre Mebazaa, François Caméléna, Jérôme Le Goff, Benoit Plaud, Emmanuel Dudoignon, Anne Clotilde Moy, Lucie Guillemet, Matthieu Lafaurie, Maxime Coutrot, Maïté Chaussard, Mélissa Budoo, François Dépret, Benjamin Deniau, Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), 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 Paris Cité (UPCité)-Université Sorbonne Paris Nord, French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), CCSD, Accord Elsevier, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, and 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

Subjects
Male, 0301 basic medicine, Microbiology (medical), Time Factors, Microbiological culture, Critical Illness, [SDV]Life Sciences [q-bio], 030106 microbiology, medicine.disease_cause, Sensitivity and Specificity, Article, Microbiology, 03 medical and health sciences, 0302 clinical medicine, Multiplex polymerase chain reaction, Pneumonia, Bacterial, medicine, Humans, 030212 general & internal medicine, Pathogen, Aged, Bacteriological Techniques, Bacteria, medicine.diagnostic_test, Pseudomonas aeruginosa, business.industry, SARS-CoV-2, Bacterial pneumonia, COVID-19, General Medicine, Rapid diagnostics, Middle Aged, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], Pneumonia, Infectious Diseases, Bronchoalveolar lavage, Staphylococcus aureus, Female, business, Bronchoalveolar Lavage Fluid, Multiplex Polymerase Chain Reaction, FilmArray Pneumonia Plus
Abstract

International audience; The FilmArray® Pneumonia Plus (FA-PP) panel can provide rapid identifications and semiquantitative results for many pathogens. We performed a prospective single-center study in 43 critically ill patients with coronavirus disease 2019 (COVID-19) in which we performed 96 FA-PP tests and cultures of blind bronchoalveolar lavage (BBAL). FA-PP detected 1 or more pathogens in 32% (31/96 of samples), whereas culture methods detected at least 1 pathogen in 35% (34/96 of samples). The most prevalent bacteria detected were Pseudomonas aeruginosa (n = 14) and Staphylococcus aureus (n = 11) on both FA-PP and culture. The FA-PP results from BBAL in critically ill patients with COVID-19 were consistent with bacterial culture findings for bacteria present in the FA-PP panel, showing sensitivity, specificity, and positive and negative predictive value of 95%, 99%, 82%, and 100%, respectively. Median turnaround time for FA-PP was 5.5 h, which was significantly shorter than for standard culture (26 h) and antimicrobial susceptibility testing results (57 h).

Published
2021
Full Text
View/download PDF

18. Perfusion Index: Physical Principles, Physiological Meanings and Clinical Implications in Anaesthesia and Critical Care

Author

Jona Joachim, Emmanuel Dudoignon, Etienne Gayat, Fabrice Vallée, François Dépret, Maxime Coutrot, Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Paris (UP), 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, Laboratoire de mécanique des solides (LMS), École polytechnique (X)-MINES ParisTech - École nationale supérieure des mines de Paris, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS), Mathematical and Mechanical Modeling with Data Interaction in Simulations for Medicine (M3DISIM), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-École polytechnique (X)-MINES ParisTech - École nationale supérieure des mines de Paris, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Inria Saclay - Ile de France, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], Université Paris Cité (UPCité), 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, École polytechnique (X)-Mines Paris - PSL (École nationale supérieure des mines de Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-École polytechnique (X)-Mines Paris - PSL (École nationale supérieure des mines de Paris), and Zunara, Fatima

Subjects
Light absorbance, Critical Care, Perfusion index, Haemodynamic monitoring, Neuraxial blockade, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Photoplethysmogram, Intensive care, Humans, Medicine, Anesthesia, Oximetry, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, Signal Processing, Computer-Assisted, 030208 emergency & critical care medicine, General Medicine, Perioperative, 3. Good health, Anesthesiology and Pain Medicine, non-invasive monitoring, Narrative review, photoplethysmography, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Short title: Clinical Usefulness of Perfusion Index; International audience; Photoplethysmography (PPG) has been extensively used for pulse oximetry monitoring in anaesthesia, perioperative and intensive care. However, some components of PPG signal have been employed for other purposes, such as non-invasive haemodynamic monitoring. Perfusion index (PI) is derived from PPG signal and represents the ratio of pulsatile on non-pulsatile light absorbance or reflectance of the PPG signal. PI determinants are complex and interlinked, involving and reflecting the interaction between peripheral and central haemodynamic characteristics, such as vascular tone and stroke volume. Recently, several studies have shed light on the interesting performances of this variable, especially assessing regional or neuraxial block success, and haemodynamic monitoring in anaesthesia, perioperative and intensive care. Nevertheless, no review has yet been published concerning the interest of PI in these fields. In this narrative review will be exposed first the physiological and pathophysiological determinants of PI, and then the mean to measure this value as well as its potential limitations. In the second part, the existing data concerning usefulness of PI in different clinical settings such as operating theatres, intensive care units and emergency departments will be presented and discussed. Finally, the perspectives concerning the use of PI and mentioned aspects that should be explored regarding this tool will be underlined.

Published
2021

19. PenKid measurement at admission is associated with outcome in severely ill burn patients

Author

Oliver Hartmann, Haikel Oueslati, Marion Jully, François Dépret, Lucie Guillemet, Matthieu Legrand, Adrien Polina, Alexandre Fratani, Alexandru Cupaciu, Maïté Chaussard, Joachim Struck, Laure Fayolle-Pivot, Sabri Soussi, Juliette Amzallag, Maxime Coutrot, Julien Textoris, Mourad Benyamina, Alexandre Mebazaa, 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, Physiopathologie de l'immunodépression associée aux réponses inflammatoires systémiques - EA 7426 (PI3), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Hôpital Edouard Herriot [CHU - HCL], and Hospices Civils de Lyon (HCL)

Subjects
Adult, Male, Burn injury, medicine.medical_specialty, Body Surface Area, Organ Dysfunction Scores, [SDV]Life Sciences [q-bio], Renal function, Poison control, Critical Care and Intensive Care Medicine, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Internal medicine, Medicine, Humans, Prospective Studies, Mortality, Protein Precursors, 10. No inequality, Survival rate, Aged, business.industry, Acute kidney injury, 030208 emergency & critical care medicine, General Medicine, Enkephalins, Acute Kidney Injury, Length of Stay, Middle Aged, medicine.disease, Peptide Fragments, 3. Good health, Renal Replacement Therapy, Intensive Care Units, Creatinine, Emergency Medicine, Biomarker (medicine), Surgery, Female, business, Burns, Total body surface area, Biomarkers
Abstract

Proenkephalin A 119-159 (penKid) has been proposed as a sensitive biomarker of renal function. This study evaluated the association of concentrations of plasma penKid with death and risk of acute kidney injury (AKI) in severely ill burn patients.A prospective observational study in two centers with severely ill adult burn patients was conducted. The inclusion criteria were total body surface area (TBSA) burns15%, with burn injury occurring72 h before intensive care unit (ICU) admission and plasma sample taken at admission. The primary endpoint was 90-day mortality. The secondary endpoints were AKI and a combined endpoint of 90-day mortality and/or AKI. Mortality was also evaluated in the sub-group of patients with sub-clinical AKI, defined as a patient without AKI but with elevated penKid.A total of 113 consecutive patients were enrolled. The median age was 48 years (Interquartile range [IQR] 33-64), the median burn TBSA was 35% (IQR 25-53), and 90-day mortality was 31.9%. Thirty-one percent of the patients had AKI, and 41.6% of patients had the combined endpoint. There was a stepwise decrease in survival from patients without AKI, sub-AKI, and with AKI (survival rate 90.0% [95% CI 82.7-97.9], 66.7% [95% CI 48.1-92.4], and 31.4% [95% CI 19.3-51.3], respectively, p0.001). Plasma penKid concentration was significantly higher in non-survivors compared to survivors (86.9 pmol/L [IQR 53.3-166.1] versus 52.9 pmol/L [IQR 37.1-70.7]; p = 0.0001) and in patients with AKI compared to patients without AKI (86.4 pmol/L [IQR 56.5-153.4] versus 52.5 pmol/L [IQR 35.5-71.2]; p0.001). Penkid provided added value on top of serum creatinine (Screat) and Sepsis Related Organ Failure Assessment (SOFA) scores to predict 90-day mortality (combined c-index of 0.738 versus 0.707; p = 0.024 and 0.787 versus 0.752; p0.001).Plasma penKid concentration at admission was associated with an increased risk of death in burn patients. PenKid has additional prognostic value on top of Screat and SOFA to predict 90-day mortality.

Published
2020
Full Text
View/download PDF

20. Low total cholesterol blood level is correlated with pulmonary severity in COVID-19 critical ill patients

Author

Nabila Moreno, Maxime Coutrot, François Dépret, Quentin Ressaire, and Emmanuel Dudoignon

Subjects
Blood level, Male, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Critical Illness, Critical Care and Intensive Care Medicine, Severity of Illness Index, chemistry.chemical_compound, Internal medicine, Severity of illness, medicine, Low total cholesterol, Humans, Letter to the Editor, Apolipoproteins A, Triglycerides, Aged, Apolipoproteins B, Retrospective Studies, business.industry, Cholesterol, SARS-CoV-2, Cholesterol, HDL, COVID-19, Retrospective cohort study, General Medicine, Cholesterol, LDL, Middle Aged, Anesthesiology and Pain Medicine, chemistry, Female, business, Respiratory Insufficiency
Published
2020

21. Bacterial Pneumonia in COVID-19 Critically Ill Patients: A Case Series

Author

François Dépret, Emmanuel Dudoignon, Adrien Habay, Béatrice Berçot, Benjamin Deniau, Quentin Ressaire, Benoit Plaud, Maxime Coutrot, and François Caméléna

Subjects
Microbiology (medical), medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Critically ill, business.industry, Coinfection, SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Critical Illness, Bacterial pneumonia, COVID-19, medicine.disease, Coronavirus, Pneumonia, AcademicSubjects/MED00290, Infectious Diseases, Anti-Infective Agents, Correspondence, Critical illness, medicine, Pneumonia, Bacterial, Humans, Intensive care medicine, business
Published
2020

23. Circulating dipeptidyl peptidase-3 at admission is associated with circulatory failure, acute kidney injury and death in severely ill burn patients

Author

Oliver Hartmann, Alexandre Fratani, Julien Textoris, Matthieu Legrand, Benjamin Deniau, Laure Fayolle-Pivot, Lucie Guillemet, Alexandru Cupaciu, Mourad Benyamina, Boris Farny, Alexandre Mebazaa, François Dépret, Etienne Gayat, Haikel Oueslati, Maxime Coutrot, Maïté Chaussard, Adrien Pollina, Karine Santos, Marion Jully, and Juliette Amzallag

Subjects
Male, Kidney Disease, Physical Injury - Accidents and Adverse Effects, Hemodynamics, PRONOBURN group, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Severity of Illness Index, Medical and Health Sciences, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Patient Admission, Clinical Research, Risk Factors, Intensive care, medicine, Clinical endpoint, Humans, Dipeptidyl peptidase-3, Prospective Studies, Mortality, Prospective cohort study, Dipeptidyl-Peptidases and Tripeptidyl-Peptidases, Aged, Burn patients, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Acute kidney injury, 030208 emergency & critical care medicine, Myocardial depressant factor, Shock, lcsh:RC86-88.9, Middle Aged, Acute Kidney Injury, medicine.disease, Prognosis, Angiotensin II, Emergency & Critical Care Medicine, Good Health and Well Being, Anesthesia, Female, business, Burns, Total body surface area, Biomarkers
Abstract

Background Dipeptidyl peptidase-3 (DPP3) is a metallopeptidase which cleaves bioactive peptides, notably angiotensin II, and is involved in inflammation regulation. DPP3 has been proposed to be a myocardial depressant factor and to be involved in circulatory failure in acute illnesses, possibly due to angiotensin II cleavage. In this study, we evaluated the association between plasmatic DPP3 level and outcome (mortality and hemodynamic failure) in severely ill burn patients. Methods In this biomarker analysis of a prospective cohort study, we included severely ill adult burn patients in two tertiary burn intensive care units. DPP3 was measured at admission (DPP3admin) and 3 days after. The primary endpoint was 90-day mortality. Secondary endpoints were hemodynamic failure and acute kidney injury (AKI). Results One hundred and eleven consecutive patients were enrolled. The median age was 48 (32.5–63) years, with a median total body surface area burned of 35% (25–53.5) and Abbreviated Burn Severity Index (ABSI) of 8 (7–11). Ninety-day mortality was 32%. The median DPP3admin was significantly higher in non-survivors versus survivors (53.3 ng/mL [IQR 28.8–103.5] versus 27.1 ng/mL [IQR 19.4–38.9]; p admin but decreased levels on day 3. Patients with circulatory failure had higher DPP3admin (39.2 ng/mL [IQR 25.9–76.1] versus 28.4 ng/mL [IQR 19.8–39.6]; p = 0.001) as well as patients with AKI (49.7 ng/mL [IQR 30.3–87.3] versus 27.6 ng/mL [IQR 19.4–41.4]; p = 0.001). DPP3admin added prognostic value on top of ABSI (added chi2 12.2, p = 0.0005), Sequential Organ Failure Assessment (SOFA) score at admission (added chi2 4.9, p = 0.0268), and plasma lactate at admission (added chi2 6.9, p = 0.0086) to predict circulatory failure within the first 48 h. Conclusions Plasma DPP3 concentration at admission was associated with an increased risk of death, circulatory failure, and AKI in severely burned patients. Whether DPP3 plasma levels could identify patients who would respond to alternative hemodynamic support strategies, such as intravenous angiotensin II, should be explored.

Published
2020

24. Outcome and potentially modifiable risk factors for candidemia in critically ill burns patients: A matched cohort study

Author

Blandine Denis, Marc Chaouat, Alexandre Alanio, Christian de Tymowski, Alexandru Cupaciu, David Boccara, François Dépret, Stéphane Bretagne, Haikel Oueslati, Maurice Mimoun, Axelle Ferry, Sabri Soussi, Matthieu Lafaurie, Maud Gits-Muselli, Emmanuel Dudoignon, Maxime Coutrot, Alexandre Fratani, James Anstey, Kevin Serror, Marion Jully, Matthieu Legrand, Maïté Chaussard, Mourad Benyamina, and Alexandre Mebazaa

Subjects
Adult, Male, 0301 basic medicine, Antifungal, medicine.medical_specialty, medicine.drug_class, Critical Illness, 030106 microbiology, Dermatology, Sepsis, 030207 dermatology & venereal diseases, 03 medical and health sciences, fluids and secretions, 0302 clinical medicine, Matched cohort, Risk Factors, hemic and lymphatic diseases, Antibiotic therapy, Internal medicine, medicine, Humans, Aged, Retrospective Studies, Icu mortality, Critically ill, Septic shock, business.industry, Candidemia, General Medicine, Middle Aged, equipment and supplies, bacterial infections and mycoses, medicine.disease, Survival Analysis, Drug Utilization, Anti-Bacterial Agents, Treatment Outcome, Infectious Diseases, Candida spp, Female, Burns, business
Abstract

BACKGROUND Patients with extensive burns are at risk of developing candidemia. OBJECTIVES To identify potentially modifiable risk factors and outcomes of candidemia in critically ill burns patients. PATIENTS AND METHODS Retrospective matched cohort study including adult burns patients. Patients who developed candidemia were matched with burns patients with Candida spp colonisation and sepsis or septic shock without candidemia in a ratio of 1:3 (same severity scores and colonisation index). Univariate and multiple regression analyses were performed. RESULTS Of 130 severely burned patients with Candida spp colonisation and at least one episode of sepsis or septic shock, 14 were diagnosed with candidemia. In the candidemia group, patients had a median (IQR) total burns surface area (TBSA) of 57 (38-68)%, SAPSII of 43 (36-58) and ABSI of 11 (8-13). Multiple regression analysis showed that only duration of prior antibiotic therapy was independently associated with candidemia. ICU mortality was higher in the candidemia group (71% vs 35% [P = 0.02]). The log-rank test for 28-day mortality comparing patients with candidemia treated with an empirical strategy vs a curative strategy did not reach significance (P = 0.056). CONCLUSIONS Burns patients having received recent antibiotherapy have a higher risk of candidemia. Antifungal strategies did not influence outcome in this series.

Published
2018
Full Text
View/download PDF

25. Thyroid Storm in the ICU: A Retrospective Multicenter Study

Author

Pierre Fillatre, Serge Carreira, Romain Sonneville, Nadia Aissaoui, Julien Charpentier, Yoann Zerbib, David Schnell, Claire Pichereau, Xavier Repessé, Yacine Tandjaoui-Lambiotte, Alexandre Lautrette, Aurélien Frérou, Etienne de Montmollin, Sami Hraiech, Romain Persichini, Matthieu Schmidt, Antoine Kimmoun, Alain Combes, Olivier Ellrodt, Maxime Coutrot, Bruno Mégarbane, Nicolas Terzi, Cecile Aubron, Keyvan Razazi, Elie Azoulay, Alexis Ferré, François Barbier, Vincent Peigne, Elise Morawiec, Danielle Reuter, Guillaume Voiriot, Clément Delmas, Saad Nseir, Naïke Bigé, Simon Bourcier, and Jean-Baptiste Lascarrou

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, 030209 endocrinology & metabolism, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, medicine, Thyroid storm, Humans, Renal replacement therapy, 10. No inequality, Survival rate, Aged, Retrospective Studies, business.industry, Mortality rate, Cardiogenic shock, Thyroid, Retrospective cohort study, Odds ratio, Middle Aged, medicine.disease, 3. Good health, Survival Rate, Intensive Care Units, medicine.anatomical_structure, Emergency medicine, Female, Thyroid Crisis, business
Abstract

Objectives Thyroid storm represents a rare but life-threatening endocrine emergency. Only rare data are available on its management and the outcome of the most severe forms requiring ICU admission. We aimed to describe the clinical manifestations, management and in-ICU and 6-month survival rates of patients with those most severe thyroid storm forms requiring ICU admission. Design Retrospective, multicenter, national study over an 18-year period (2000-2017). Setting Thirty-one French ICUs. Patients The local medical records of patients from each participating ICU were screened using the International Classification of Diseases, 10th Revision. Inclusion criteria were "definite thyroid storm," as defined by the Japanese Thyroid Association criteria, and at least one thyroid storm-related organ failure. Measurements and main results Ninety-two patients were included in the study. Amiodarone-associated thyrotoxicosis and Graves' disease represented the main thyroid storm etiologies (30 [33%] and 24 [26%] patients, respectively), while hyperthyroidism was unknown in 29 patients (32%) before ICU admission. Amiodarone use (24 patients [26%]) and antithyroid-drug discontinuation (13 patients [14%]) were the main thyroid storm-triggering factors. No triggering factor was identified for 30 patients (33%). Thirty-five patients (38%) developed cardiogenic shock within the first 48 hours after ICU admission. In-ICU and 6-month postadmission mortality rates were 17% and 22%, respectively. ICU nonsurvivors more frequently required vasopressors, extracorporeal membrane of oxygenation, renal replacement therapy, mechanical ventilation, and/or therapeutic plasmapheresis. Multivariable analyses retained Sequential Organ Failure Assessment score without cardiovascular component (odds ratio, 1.22; 95% CI, 1.03-1.46; p = 0.025) and cardiogenic shock within 48 hours post-ICU admission (odds ratio, 9.43; 1.77-50.12; p = 0.008) as being independently associated with in-ICU mortality. Conclusions Thyroid storm requiring ICU admission causes high in-ICU mortality. Multiple organ failure and early cardiogenic shock seem to markedly impact the prognosis, suggesting a prompt identification and an aggressive management.

Published
2019

26. Acute Kidney Injury Induces Remote Cardiac Damage and Dysfunction Through the Galectin-3 Pathway

Author

Françoise Poirier, Etienne Gayat, Claude Delcayre, Jean-Marie Launay, Thibault Michel, Bocar Kane, Satoshi Kinugasa, Alain Cohen-Solal, Magali Genest, Matthieu Legrand, Maxime Coutrot, Louis Boutin, Sophie Vandermeersch, Christos E. Chadjichristos, Alexandre Mebazaa, Mathilde Prud’homme, Ravindra L. Mehta, Niki Prakoura, Jane-Lise Samuel, 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, Des Maladies Rénales Rares aux Maladies Fréquentes, Remodelage et Réparation, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Phénotypage du petit animal (UMS28), Sorbonne Université (SU), 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, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Investigation Network Initiative Cardiovascular and Rénal Clinical Trialist (INI-CRCT), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Jacques Monod (IJM (UMR_7592)), Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), University of California [San Diego] (UC San Diego), University of California (UC), and Chadjichristos, Christos

Subjects
WT, wild type, lcsh:Diseases of the circulatory (Cardiovascular) system, renal failure, BUN, blood urea nitrogen, heart failure, ICAM, intercellular adhesion molecule, Cardiovascular, intensive care unit, law.invention, PRECLINICAL RESEARCH, 0302 clinical medicine, Fibrosis, Aetiology, Gal-3, galectin-3, UUO, WT, interleukin, eGFR, estimated glomerular filtration rate, Acute kidney injury, creatinine, 3. Good health, macrophages, Kidney Disease Improving Global Outcome, unilateral ureteral obstruction, Galectin-3, intercellular adhesion molecule, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Clinical Sciences, Renal and urogenital, 03 medical and health sciences, BM, IR, ischemia-reperfusion, NT-proBNP, N-terminal-pro-brain natriuretic peptide, KDIGO, Kidney Disease Improving Global Outcome, Prevention, IL, Gal-3, medicine.disease, IL, interleukin, 030104 developmental biology, lcsh:RC666-701, NT-proBNP, IR, 0301 basic medicine, transforming growth factor, Kidney Disease, estimated glomerular filtration rate, [SDV]Life Sciences [q-bio], TNF, Cr, creatinine, 030204 cardiovascular system & hematology, Cardiorespiratory Medicine and Haematology, ischemia-reperfusion, MCP, modified citrus pectin, law, eGFR, 2.1 Biological and endogenous factors, KO, knock-out, TGF, transforming growth factor, Cr, KDIGO, TNF, tumor necrosis factor, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Blocking (radio), KO, Intensive care unit, ICU, intensive care unit, TGF, Heart Disease, acute kidney injury, Cardiology, wild type, medicine.symptom, ICAM, bone marrow, tumor necrosis factor, Inflammation, AKI, acute kidney injury, Immune system, AKI, Internal medicine, BUN, galectin-3, medicine, UUO, unilateral ureteral obstruction, blood urea nitrogen, knock-out, N-terminal-pro-brain natriuretic peptide, business.industry, fibrosis, Good Health and Well Being, modified citrus pectin, inflammation, Heart failure, MCP, ICU, BM, bone marrow, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Visual Abstract, Highlights • In 2 different mouse models, AKI increased Gal-3 expression and induced cardiac dysfunction, cardiac and systemic inflammation, cardiac macrophage infiltration, and fibrosis. • Cardiac consequences of AKI were dependent on the Gal-3 pathway and were prevented using Gal-3 knockout mice or modified citrus pectin as a pharmaceutical inhibitor. • Cardiac Gal-3 expression resulted from bone marrow-derived immune cells recruitment after AKI. • In critically ill patients, development of AKI is associated with increased plasma Gal-3 levels and increased biomarkers of cardiac injury and damage., Summary Acute kidney injury is associated with increased risk of heart failure and mortality. This study demonstrates that acute kidney injury induces remote cardiac dysfunction, damage, injury, and fibrosis via a galectin-3 (Gal-3) dependent pathway. Gal-3 originates from bone marrow-derived immune cells. Cardiac damage could be prevented by blocking this pathway.

Published
2019
Full Text
View/download PDF

27. Arrêt ou poursuite des antihypertenseurs en peropératoire ? Le point de vue de l’anesthésiste-réanimateur

Author

Etienne Gayat, Matthieu Legrand, Maxime Coutrot, 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 Paris Cité (UPCité)-Université Sorbonne Paris Nord, Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CCSD, Accord Elsevier, and 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

Subjects
[SDV] Life Sciences [q-bio], 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, hypertension, complication of anesthesia, 030202 anesthesiology, [SDV]Life Sciences [q-bio], Emergency Medicine, antihypertensive agent, Emergency Nursing, 030217 neurology & neurosurgery, 3. Good health
Abstract

Resume L’anesthesie d’un patient hypertendu traite est une situation frequente et a risque de complications cardiovasculaires. Une evaluation cardiovasculaire doit etre faite avant intervention chez ces patients. L’instabilite hemodynamique per-anesthesie est particulierement deletere dans ce contexte. Les traitements betabloquants doivent etre poursuivis en perioperatoire, mais il n’y a pas d’argument en faveur de leur introduction. Les recommandations europeennes, mais pas nord-americaines sont d’arreter les IEC et les ARA2 avant l’anesthesie sauf en cas d’insuffisance cardiaque. Les inhibiteurs calciques ne necessitent pas un arret. Les diuretiques sont arretes le jour de l’intervention et leurs consequences sur l’equilibre ionique doivent etre verifiees. L’introduction de la clonidine avant l’anesthesie n’est pas justifiee.

Published
2019
Full Text
View/download PDF

28. Real-time estimation of mean arterial blood pressure based on photoplethysmography dicrotic notch and perfusion index. A pilot study

Author

Jona, Joachim, Maxime, Coutrot, Sandrine, Millasseau, Joaquim, Matéo, Alexandre, Mebazaa, Etienne, Gayat, and Fabrice, Vallée

Subjects
Perfusion Index, Humans, Arterial Pressure, Blood Pressure, Blood Pressure Determination, Pilot Projects, Anesthesia, General, Photoplethysmography
Abstract

Hypotension during general anesthesia is associated with poor outcome. Continuous monitoring of mean blood pressure (MAP) during anesthesia is useful and needs to be reliable and minimally invasive. Conventional cuff measurements can lead to delays due to its discontinuous nature. It has been shown that there is a relationship between MAP and photoplethysmography (PPG) parameters like the dicrotic notch and perfusion index (PI). The objective of the study was to continuously estimate MAP from PPG. Pulse wave analysis based on PPG was implemented using either notch relative amplitude (MAP

Published
2019

29. Noninvasive continuous detection of arterial hypotension during induction of anaesthesia using a photoplethysmographic signal: proof of concept

Author

Maxime Coutrot, François Dépret, Etienne Gayat, Fabrice Vallée, Sandrine Millasseau, Hélène Nougué, Alexandre Mebazaa, Jona Joachim, Joaquim Mateo, Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), 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)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris-Sud - Paris 11 (UP11)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7), Université Paris Diderot - Paris 7 (UPD7), Pulse wave consulting [Saint-Leu-la-forêt], Mathematical and Mechanical Modeling with Data Interaction in Simulations for Medicine (M3DISIM), Laboratoire de mécanique des solides (LMS), École polytechnique (X)-MINES ParisTech - École nationale supérieure des mines de Paris, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-École polytechnique (X)-MINES ParisTech - École nationale supérieure des mines de Paris, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Inria Saclay - Ile de France, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria), Université Paris 13 (UP13)-Université Paris-Sud - Paris 11 (UP11)-Université Paris Diderot - Paris 7 (UPD7)-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), École polytechnique (X)-Mines Paris - PSL (École nationale supérieure des mines de Paris), and Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-École polytechnique (X)-Mines Paris - PSL (École nationale supérieure des mines de Paris)

Subjects
Adult, Male, Mean arterial pressure, [SDV]Life Sciences [q-bio], Remifentanil, Hemodynamics, Blood Pressure, Anesthesia, General, Proof of Concept Study, Sensitivity and Specificity, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Photoplethysmogram, Monitoring, Intraoperative, medicine, Humans, Vasoconstrictor Agents, General anaesthesia, Prospective Studies, Intraoperative Complications, Photoplethysmography, Intraoperative Care, medicine.diagnostic_test, Receiver operating characteristic, business.industry, Blood Pressure Determination, Middle Aged, Pulse oximetry, Anesthesiology and Pain Medicine, Anesthesia, Female, Hypotension, business, Propofol, medicine.drug
Abstract

Background During general anaesthesia, intraoperative hypotension (IOH), defined as a mean arterial pressure (MAP) reduction of > 20%, is frequent and may lead to complications. Pulse oximetry is mandatory in the operating room, making the photoplethysmographic signal and parameters, such as relative dicrotic notch height (Dicpleth) or perfusion index (PI), readily available. The purpose of this study was to investigate whether relative variations of Dicpleth and PI could detect IOH during anaesthesia induction, and to follow their variations during vasopressor boluses. Methods MAP, Dicpleth, and PI were monitored at 1-min intervals during target control induction of anaesthesia with propofol and remifentanil in 61 subjects. Vasopressor infusion (norepinephrine or phenylephrine) was performed when hypotension occurred according to the decision of the physician. Results The delta in Dicpleth and PI accurately detected IOH, with areas under the receiver operating characteristic curves (AUC) of 0.86 and 0.83, respectively. The optimal thresholds were –19% (sensitivity 79%; specificity 84%) and 51% (sensitivity 82%; specificity 74%) for ΔDicpleth and ΔPI, respectively. There was no difference between the ROC of ΔDicpleth and ΔPI (P=0.22). Combining both ΔDicpleth and ΔPI further improved the hypotension detection power (AUC=0.91) with a sensitivity and specificity of 84%. MAP variations were correlated with ΔDicpleth and ΔPI during vasopressor infusion (r=0.73 and –0.62, respectively; P Conclusions The relative variation in Dicpleth and PI derived from the photoplethysmographic signal can be used as a non invasive, continuous, and simple tool to detect intraoperative hypotension, and to track the vascular response to vasoconstrictor drugs during induction of general anaesthesia. Clinical trial registration NCT03756935 .

Published
2019
Full Text
View/download PDF

30. Hemodynamics and Extracorporeal Circulation

Author

Alain Combes, Maxime Coutrot, and Nicolas Bréchot

Subjects
medicine.medical_specialty, business.industry, Cardiogenic shock, Extracorporeal circulation, Hemodynamics, Blood flow, Stroke volume, Pulmonary edema, medicine.disease, Microcirculation, surgical procedures, operative, Afterload, Internal medicine, cardiovascular system, medicine, Cardiology, business
Abstract

Peripheral veno-arterial membrane oxygenation (PVA-ECMO) is increasingly used as first-line therapy during refractory cardiogenic shock. It is responsible for striking changes in patient’s hemodynamics. They are mostly related to the retrograde direction of the ECMO blood flow in the aorta, responsible for a massive increase in cardiac afterload and a massive reduction in the residual stroke volume of the native heart. Both effects put the patient at risk for pulmonary edema and blood stagnation in the heart, which can be lowered by setting the lowest possible ECMO blood flow, maintaining inotropes and diuretics, and eventually combining an intra-aortic balloon pump to ECMO support. Compared to PVA-ECMO, central cannulation has a more physiological blood flow direction, responsible for less increase in cardiac afterload, and better left ventricular unloading. Restoring a normal pulsatility under ECMO remains debated, both for its effects on systemic vascular resistances and on microcirculation.

Published
2019
Full Text
View/download PDF

31. Euglycemic ketoacidosis, a common and underecognized complication of continuous renal replacement therapy using glucose-free solutions

Author

Matthieu Schmidt, Ania Nieszkowska, Guillaume Hékimian, Alain Combes, Simon Bourcier, Sébastien Besset, Guillaume Franchineau, Olivier Bourron, Charles-Edouard Luyt, Maxime Coutrot, Thibaut Moulin, and Nicolas Bréchot

Subjects
Blood Glucose, medicine.medical_specialty, business.industry, Pain medicine, medicine.medical_treatment, 030232 urology & nephrology, MEDLINE, Ketosis, Critical Care and Intensive Care Medicine, medicine.disease, Ketoacidosis, Renal Replacement Therapy, 03 medical and health sciences, 0302 clinical medicine, Glucose, Anesthesiology, medicine, Humans, Hypoglycemic Agents, 030212 general & internal medicine, Renal replacement therapy, Intensive care medicine, business, Complication, Acidosis
Published
2018

32. Is Nitric Oxide Nephro- or Cardioprotective?

Author

Matthieu Legrand, Maxime Coutrot, and François Dépret

Subjects
Pulmonary and Respiratory Medicine, business.industry, MEDLINE, Acute kidney injury, 030208 emergency & critical care medicine, Pharmacology, Critical Care and Intensive Care Medicine, medicine.disease, Nitric oxide, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Text mining, 030228 respiratory system, chemistry, Medicine, business
Published
2019
Full Text
View/download PDF

33. Six-Month outcome of immunocompromised patients with severe acute respiratory distress syndrome rescued by extracorporeal membrane oxygenation. An international multicenter retrospective study

Author

Matthieu Schmidt, Peter Schellongowski, Nicolò Patroniti, Fabio Silvio Taccone, Dinis Reis Miranda, Jean Reuter, Helène Prodanovic, Marc Pierrot, Amandine Dorget, Sunghoon Park, Martin Balik, Alexandre Demoule, Ilaria Alice Crippa, Alain Mercat, Philipp Wohlfarth, Romain Sonneville, Alain Combes, Lila Bouadma, Jean-Francois Timsit, Alexandre Brasseur, Olivier Lheureux, Jacques Creteur, Philippe Lemaitre, Xavier Bechtold, Gerdy Debeuckelaere, Franky Partipilo, Robert van Thiel, Corstiaan den Uil, Jan Rulisek, Petr Kopecky, Jan Kunstyr, Michela Bombino, Jonata Pizzagalli, Alessandra Ponti, Antonio Pesenti, Hyoung Soo Kim, Charles-Edouard Luyt, Nicolas Bréchot, Guillaume Hékimian, Sébastien Besset, Maxime Coutrot, Ania Nieszkowska, Simon Bourcier, Guillaume Lebreton, Pascal Leprince, Julien Mayaux, Hélène Prodanovic, Andja Bojic, Nina Buchtele, Alexander Hermann, Peter Jaksch, Oliver Robak, Wolfgang R. Sperr, Thomas Staudinger, International ECMO Network (ECMONet), REVA Research Network, IDEA Study Group, Schmidt, M, Schellongowski, P, Patroniti, N, Taccone, F, Reis Miranda, D, Reuter, J, Prodanovic, H, Pierrot, M, Dorget, A, Park, S, Balik, M, Demoule, A, Crippa, I, Mercat, A, Wohlfarth, P, Sonneville, R, and Combes, A

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, Acute respiratory distress, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Immunocompromised Host, 0302 clinical medicine, Internal medicine, medicine, Extracorporeal membrane oxygenation, extracorporeal membrane oxygenation, acute respiratory distress syndrome, immunodeficiency, outcome, hematological malignancies, Humans, hematological malignancies, Immunodeficiency, Retrospective Studies, Respiratory Distress Syndrome, business.industry, 030208 emergency & critical care medicine, Retrospective cohort study, Original Articles, extracorporeal membrane oxygenation, acute respiratory distress syndrome, medicine.disease, Respiration, Artificial, 3. Good health, surgical procedures, operative, 030228 respiratory system, outcome, Human medicine, business, immunodeficiency
Abstract

Rationale: Because encouraging rates for hospital and long-term survival of immunocompromised patients in ICUs have been described, these patients are more likely to receive invasive therapies, like extracorporeal membrane oxygenation (ECMO). Objectives: To report outcomes of immunocompromised patients treated with ECMO for severe acute respiratory distress syndrome (ARDS) and to identify their pre-ECMO predictors of 6-month mortality and main ECMO-related complications. Methods: Retrospective multicenter study in 10 international ICUs with high volumes of ECMO cases. Immunocompromised patients, defined as having hematological malignancies, active solid tumor, solid-organ transplant, acquired immunodeficiency syndrome, or long-term or high-dose corticosteroid or immunosuppressant use, and severe ECMO-treated ARDS, from 2008 to 2015 were included. Measurements and Main Results: We collected demographics, clinical data, ECMO-related complications, and ICU- and 6 month–outcome data for 203 patients (median Acute Physiology and Chronic Health Evaluation II score, 28 [25th–75th percentile, 20–33]; age, 51 [38–59] yr; Pa(O(2))/Fi(O(2)), 60 [50–82] mm Hg before ECMO) who fulfilled our inclusion criteria. Six-month survival was only 30%, with a respective median ECMO duration and ICU stay of 8 (5–14) and 25 (16–50) days. Patients with hematological malignancies had significantly poorer outcomes than others (log-rank P = 0.02). ECMO-related major bleeding, cannula infection, and ventilator-associated pneumonia were frequent (36%, 10%, and 50%, respectively). Multivariate analyses retained fewer than 30 days between immunodeficiency diagnosis and ECMO cannulation as being associated with lower 6-month mortality (odds ratio, 0.32 [95% confidence interval, 0.16–0.66]; P = 0.002), and lower platelet count, higher Pco(2), age, and driving pressure as independent pre-ECMO predictors of 6-month mortality. Conclusions: Recently diagnosed immunodeficiency is associated with a much better prognosis in ECMO-treated severe ARDS. However, low 6-month survival of our large cohort of immunocompromised patients supports restricting ECMO to patients with realistic oncological/therapeutic prognoses, acceptable functional status, and few pre-ECMO mortality-risk factors.

Published
2018

34. Prediction of major adverse kidney events in critically ill burn patients

Author

Klára Benešová, Aurélien Bataille, Axelle Ferry, Jiří Parenica, Mourad Benyamina, Alexandre Mebazaa, Jean-Pierre Garnier, Maxime Coutrot, Jiří Jarkovský, Matthieu Legrand, Christian de Tymowski, Maïté Chaussard, Haikel Oueslati, Alexandru Cupaciu, Nabila Moreno, Sabri Soussi, Louis Boutin, Thomas Vauchel, François Dépret, Kevin Serror, and M. Chaouat

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Critical Illness, Population, Critical Care and Intensive Care Medicine, Risk Assessment, law.invention, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Lipocalin-2, law, Internal medicine, medicine, Humans, 030212 general & internal medicine, Renal replacement therapy, Prospective Studies, Mortality, 10. No inequality, education, Aged, Body surface area, education.field_of_study, Kidney, business.industry, Critically ill, Acute kidney injury, 030208 emergency & critical care medicine, General Medicine, Recovery of Function, Acute Kidney Injury, Middle Aged, medicine.disease, Prognosis, Intensive care unit, 3. Good health, Renal Replacement Therapy, Intensive Care Units, medicine.anatomical_structure, Creatinine, Emergency Medicine, Surgery, Female, business, Burns, Cohort study
Abstract

We aimed at assessing the predictive value of plasmatic Neutrophil Gelatinase Associated Lipocalin (pNGAL) at admission and severity scores to predict major adverse kidney events (MAKE, defined as death and/or need for renal replacement therapy (RRT) and/or non-renal recovery at day 90) in critically ill burn patients.Single-center cohort study in a burn critical care unit in a tertiary center, including all consecutive severely burn patients (total burned body surface20%) from January 2012 until January 2015 with a pNGAL dosage at admission. Reclassification of patients was assessed by Integrated Discrimination Improvement (IDI).87 patients were included. Mean age was 47.7 (IQ 25-75: 33.4-65.2) years; total burn body surface area was 40 (IQ 25-75: 30-55) % and ICU mortality 36%. 39 (44.8%) patients presented a MAKE, 32 (88.9%) patients died at day 90. pNGAL was higher in the MAKE group (423 [IQ 25-75: 327-518]pg/mL vs 184 [IQ 25-75: 147-220]pg/mL, p0.001). In multivariate analysis, pNGAL and abbreviated burn severity index (ABSI) remained associated with MAKE (OR 1.005 [CI 95% 1.0005-1.009], p=0.03 and OR 1.682 [CI95%1.038-2.726], p=0.035 respectively). Adding pNGAL to abbreviated burn severity index, simplified organ failure assessment and the simplified acute physiology score 2 did outperform clinical scores for the prediction of MAKE and AKI and for most severe forms of AKI and allowed a statistically significant reclassification of patients compared to ABSI for MAKE, RRT, AKI at Day 7 and AKI during hospitalization with a number of patients needed to screen to detect one extra episode of MAKE was 44, 13 for severe AKI and 15 for AKI.pNGAL at admission is associated with the risk of MAKE in this population, and outperform severity scores when associated. Interventional studies are now needed to assess if impact of biomarkers-guided strategies would improve outcome.

Published
2017

35. Commentary: Posterior Reversible Encephalopathy Syndrome as a Complication of Induced Hypertension in Subarachnoid Hemorrhage: A Case-Control Study

Author

Maxime Coutrot and François Dépret

Subjects
medicine.medical_specialty, Subarachnoid hemorrhage, business.industry, Case-control study, Posterior reversible encephalopathy syndrome, medicine.disease, Reversible posterior leukoencephalopathy syndrome, Surgery, Text mining, medicine, Neurology (clinical), business, Complication
Published
2018
Full Text
View/download PDF

36. Characteristics, management, and prognosis of elderly patients with COVID-19 admitted in the ICU during the first wave: insights from the COVID-ICU study

Author

Dres, Martin, Hajage, David, Lebbah, Said, Kimmoun, Antoine, Pham, Tai, Béduneau, Gaëtan, Combes, Alain, Mercat, Alain, Guidet, Bertrand, Demoule, Alexandre, Schmidt, Matthieu, Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Hôpital Bicêtre, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Groupe de Recherche sur le Handicap Ventilatoire et Neurologique (GRHVN), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU Rouen, Normandie Université (NU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Université d'Angers (UA), CHU Saint-Antoine [AP-HP], COVID-ICU investigators: Alain Mercat, Pierre Asfar, François Beloncle, Julien Demiselle, Tài Pham, Arthur Pavot, Xavier Monnet, Christian Richard, Alexandre Demoule, Martin Dres, Julien Mayaux, Alexandra Beurton, Cédric Daubin, Richard Descamps, Aurélie Joret, Damien Du Cheyron, Frédéric Pene, Jean-Daniel Chiche, Mathieu Jozwiak, Paul Jaubert, Guillaume Voiriot, Muriel Fartoukh, Marion Teulier, Clarisse Blayau, Erwen L'Her, Cécile Aubron, Laetitia Bodenes, Nicolas Ferriere, Johann Auchabie, Anthony Le Meur, Sylvain Pignal, Thierry Mazzoni, Jean-Pierre Quenot, Pascal Andreu, Jean-Baptiste Roudau, Marie Labruyère, Saad Nseir, Sébastien Preau, Julien Poissy, Daniel Mathieu, Sarah Benhamida, Rémi Paulet, Nicolas Roucaud, Martial Thyrault, Florence Daviet, Sami Hraiech, Gabriel Parzy, Aude Sylvestre, Sébastien Jochmans, Anne-Laure Bouilland, Mehran Monchi, Marc Danguy des Déserts, Quentin Mathais, Gwendoline Rager, Pierre Pasquier, Reignier Jean, Seguin Amélie, Garret Charlotte, Canet Emmanuel, Jean Dellamonica, Clément Saccheri, Romain Lombardi, Yanis Kouchit, Sophie Jacquier, Armelle Mathonnet, Mai-AhnNay, Isabelle Runge, Frédéric Martino, Laure Flurin, Amélie Rolle, Michel Carles, Rémi Coudroy, Arnaud W Thille, Jean-Pierre Frat, Maeva Rodriguez, Pascal Beuret, Audrey Tientcheu, Arthur Vincent, Florian Michelin, Marie Anne Melone, Maxime Gauzi, Arnaud Guilbert, Geoffrey Kouadri, Valérie Gissot, Stéphan Ehrmann, Charlotte Salmon Gandonniere, Djlali Elaroussi, Agathe Delbove, Yannick Fedun, Julien Huntzinger, Eddy Lebas, Grâce Kisoka, Céline Grégoire, Stella Marchetta, Bernard Lambermont, Laurent Argaud, Thomas Baudry, Pierre-Jean Bertrand, Auguste Dargent, Christophe Guitton, Nicolas Chudeau, Mickaël Landais, Cédric Darreau, Alexis Ferre, Antoine Gros, Guillaume Lacave, Fabrice Bruneel, Mathilde Neuville, Jérôme Devaquet, Guillaume Tachon, Richard Gallot, Riad Chelha, Arnaud Galbois, Anne Jallot, Ludivine Chalumeau Lemoine, Khaldoun Kuteifan, Valentin Pointurier, Louise-Marie Jandeaux, Joy Mootien, Charles Damoisel, Benjamin Sztrymf, Matthieu Schmidt, Alain Combes, Juliette Chommeloux, Charles Edouard Luyt, Frédérique Schortgen, Leon Rusel, Camille Jung, Florent Gobert, Damien Vimpere, Lionel Lamhaut, Bertrand Sauneuf, Liliane Charrrier, Julien Calus, Isabelle Desmeules, Benoît Painvin, Jean-Marc Tadie, Vincent Castelain, Baptiste Michard, Jean-Etienne Herbrecht, Mathieu Baldacini, Nicolas Weiss, Sophie Demeret, Clémence Marois, Benjamin Rohaut, Pierre-Henri Moury, Anne-Charlotte Savida, Emmanuel Couadau, Mathieu Série, Nica Alexandru, Cédric Bruel, Candice Fontaine, Sonia Garrigou, Juliette Courtiade Mahler, Maxime Leclerc, Michel Ramakers, Pierre Garçon, Nicole Massou, Ly Van Vong, Juliane Sen, Nolwenn Lucas, Franck Chemouni, Annabelle Stoclin, Alexandre Avenel, Henri Faure, Angélie Gentilhomme, Sylvie Ricome, Paul Abraham, Céline Monard, Julien Textoris, Thomas Rimmele, Florent Montini, Gabriel Lejour, Thierry Lazard, Isabelle Etienney, Younes Kerroumi, Claire Dupuis, Marine Bereiziat, Elisabeth Coupez, François Thouy, Clémet Hoffmann, Nicolas Donat, Violaine Muller, Thibault Martinez, Antoine Kimmoun, Audrey Jacquot, Matthieu Mattei, Bruno Levy, Ramin Ravan, Loïc Dopeux, Jean-Mathias Liteaudon, Delphine Roux, Brice Rey, Radu Anghel, Deborah Schenesse, Vincent Gevrey, Jermy Castanera, Philippe Petua, Benjamin Madeux, Otto Hartman, Michael Piagnerelli, Anne Joosten, Cinderella Noel, Patrick Biston, Thibaut Noel, Gurvan L E Bouar, Messabi Boukhanza, Elsa Demarest, Marie-France Bajolet, Nathanaël Charrier, Audrey Quenet, Cécile Zylberfajn, Nicolas Dufour, Buno Mégarbane, SqébastianVoicu, Nicolas Deye, Isabelle Malissin, François Legay, Matthieu Debarre, Nicolas Barbarot, Pierre Fillatre, Bertrand Delord, Thomas Laterrade, Tahar Saghi, Wilfried Pujol, Pierre Julien Cungi, Pierre Esnault, Mickael Cardinale, Vivien Hong Tuan Ha, Grégory Fleury, Marie-Ange Brou, Daniel Zafimahazo, David Tran-Van, Patrick Avargues, Lisa Carenco, Nicolas Robin, Alexandre Ouali, Lucie Houdou, Christophe Le Terrier, Noémie Suh, Steve Primmaz, Jérome Pugin, Emmanuel Weiss, Tobias Gauss, Jean-Denis Moyer, Catherine Paugam Burtz, Béatrice La Combe, Rolland Smonig, Jade Violleau, Pauline Cailliez, Jonathan Chelly, Antoine Marchalot, Cécile Saladin, Christelle Bigot, Pierre-Marie Fayolle, Jules Fatséas, Amr Ibrahim, Dabor Resiere, Rabih Hage, Clémentine Cholet, Marie Cantier, Pierre Trouiler, Philippe Montravers, Brice Lortat-Jacob, Sebastien Tanaka, Alexy Tran Dinh, Jacques Duranteau, Anatole Harrois, Guillaume Dubreuil, Marie Werner, Anne Godier, Sophie Hamada, Diane Zlotnik, Hélène Nougue, Armand Mekontso-Dessap, Guillaume Carteaux, Keyvan Razazi, Nicolas De Prost, Nicolas Mongardon, Olivier Langeron, Eric Levesque, Arié Attias, Charles de Roquetaillade, Benjamin G Chousterman, Alexandre Mebazaa, Etienne Gayat, Marc Garnier, Emmanuel Pardo, Lea Satre-Buisson, Christophe Gutton, Elise Yvin, Clémence Marcault, Elie Azoulay, Michael Darmon, Hafid Ait Oufella, Geoffroy Hariri, Tomas Urbina, Sandie Mazerand, Nicholas Heming, Francesca Santi, Pierre Moine, Djillali Annane, Adrien Bouglé, Edris Omar, Aymeric Lancelot, Emmanuelle Begot, Gaétan Plantefeve, Damien Contou, Hervé Mentec, Olivier Pajot, Stanislas Faguer, Olivier Cointault, Laurence Lavayssiere, Marie-Béatrice Nogier, Matthieu Jamme, Claire Pichereau, Jan Hayon, Hervé Outin, François Dépret, Maxime Coutrot, Maité Chaussard, Lucie Guillemet, Pierre Goffin, Romain Thouny, Julien Guntz, Laurent Jadot, Romain Persichini, Vanessa Jean-Michel, Hugues Georges, Thomas Caulier, Gaël Pradel, Marie-Hélène Hausermann, ThiMy Hue Nguyen-Valat, Michel Boudinaud, Emmanuel Vivier, Sylvène Rosseli, Gaël Bourdin, Christian Pommier, Marc Vinclair, Simon Poignant, Sandrine Mons, Wulfran Bougouin, Franklin Bruna, Quentin Maestraggi, Christian Roth, Laurent Bitker, François Dhelft, Justine Bonnet-Chateau, Mathilde Filippelli, Tristan Morichau-Beauchant, Stéphane Thierry, Charlotte Le Roy, Mélanie Saint Jouan, Bruno Goncalves, Aurélien Mazeraud, Matthieu Daniel, Tarek Sharshar, Cyril Cadoz, RostaneGaci, Sébastien Gette, Guillaune Louis, Sophe-Caroline Sacleux, Marie-Amélie Ordan, Aurélie Cravoisy, Marie Conrad, Guilhem Courte, Sébastien Gibot, Younès Benzidi, Claudia Casella, Laurent Serpin, Jean-Lou Setti, Marie-Catherine Besse, Anna Bourreau, Jérôme Pillot, Caroline Rivera, Camille Vinclair, Marie-Aline Robaux, Chloé Achino, Marie-Charlotte Delignette, Tessa Mazard, Frédéric Aubrun, Bruno Bouchet, Aurélien Frérou, Laura Muller, Charlotte Quentin, Samuel Degoul, Xavier Stihle, Claude Sumian, Nicoletta Bergero, Bernard Lanaspre, Hervé Quintard, Eve Marie Maiziere, Pierre-Yves Egreteau, Guillaume Leloup, Florin Berteau, Marjolaine Cottrel, Marie Bouteloup, Matthieu Jeannot, Quentin Blanc, Julien Saison, Isabelle Geneau, Romaric Grenot, Abdel Ouchike, Pascal Hazera, Anne-Lyse Masse, Suela Demiri, Corinne Vezinet, Elodie Baron, Deborah Benchetrit, Antoine Monsel, Grégoire Trebbia, Emmanuelle Schaack, Raphaël Lepecq, Mathieu Bobet, Christophe Vinsonneau, Thibault Dekeyser, Quentin Delforge, Imen Rahmani, Bérengère Vivet, Jonathan Paillot, Lucie Hierle, Claire Chaignat, Sarah Valette, Benoït Her, Jennifier Brunet, Mathieu Page, Fabienne Boiste, Anthony Collin, Florent Bavozet, Aude Garin, Mohamed Dlala, Kais Mhamdi, Bassem Beilouny, Alexandra Lavalard, Severine Perez, Benoit Veber, Pierre-Gildas Guitard, Philippe Gouin, Anna Lamacz, Fabienne Plouvier, Bertrand P Delaborde, Aïssa Kherchache, Amina Chaalal, Jean-Damien Ricard, Marc Amouretti, Santiago Freita-Ramos, Damien Roux, Jean-Michel Constantin, Mona Assefi, Marine Lecore, Agathe Selves, Florian Prevost, Christian Lamer, Ruiying Shi, Lyes Knani, Sébastien PiliFloury, Lucie Vettoretti, Michael Levy, Lucile Marsac, Stéphane Dauger, Sophie Guilmin-Crépon, Hadrien Winiszewski, Gael Piton, Thibaud Soumagne, Gilles Capellier, Jean-Baptiste Putegnat, Frédérique Bayle, Maya Perrou, Ghyslaine Thao, Guillaume Géri, Cyril Charron, Xavier Repessé, Antoine Vieillard-Baron, Mathieu Guilbart, Pierre-Alexandre Roger, Sébastien Hinard, Pierre-Yves Macq, Kevin Chaulier, Sylvie Goutte, Patrick Chillet, Anaïs Pitta, Barbara Darjent, Amandine Bruneau, Sigismond Lasocki, Maxime Leger, Soizic Gergaud, Pierre Lemarie, Nicolas Terzi, Carole Schwebel, Anaïs Dartevel, Louis-Marie Galerneau, Jean-Luc Diehl, Caroline Hauw-Berlemont, Nicolas Péron, Emmanuel Guérot, Abolfazl Mohebbi Amoli, Michel Benhamou, Jean-Pierre Deyme, Olivier Andremont, Diane Lena, Julien Cady, Arnaud Causeret, Arnaud De La Chapelle, Christophe Cracco, Stéphane Rouleau, David Schnell, Camille Foucault, Cécile Lory, Thibault Chapelle, Vincent Bruckert, Julie Garcia, Abdlazize Sahraoui, Nathalie Abbosh, Caroline Bornstain, Pierre Pernet, Florent Poirson, Ahmed Pasem, Philippe Karoubi, Virginie Poupinel, Caroline Gauthier, François Bouniol, Philippe Feuchere, Florent Bavozet, Anne Heron, Serge Carreira, Malo Emery, Anne Sophie Le Floch, Luana Giovannangeli, Nicolas Herzog, Christophe Giacardi, Thibaut Baudic, Chloé Thill, Said Lebbah, Jessica Palmyre, Florence Tubach, David Hajage, Nicolas Bonnet, Nathan Ebstein, Stéphane Gaudry, Yves Cohen, Julie Noublanche, Olivier Lesieur, Arnaud Sément, Isabel Roca-Cerezo, Michel Pascal, Nesrine Sma, Gwenhaël Colin, Jean-Claude Lacherade, Gauthier Bionz, Natacha Maquigneau, Pierre Bouzat, Michel Durand, Marie-Christine Hérault, Jean-Francois Payen, and dres, martin

Subjects
[SDV] Life Sciences [q-bio], Acute respiratory distress syndrome, Frailty, [SDV]Life Sciences [q-bio], Old patients, COVID-19, Intensive care unit, Mortality, Intubation
Abstract

International audience; Abstract Background The COVID-19 pandemic is a heavy burden in terms of health care resources. Future decision-making policies require consistent data on the management and prognosis of the older patients (> 70 years old) with COVID-19 admitted in the intensive care unit (ICU). Methods Characteristics, management, and prognosis of critically ill old patients (> 70 years) were extracted from the international prospective COVID-ICU database. A propensity score weighted-comparison evaluated the impact of intubation upon admission on Day-90 mortality. Results The analysis included 1199 (28% of the COVID-ICU cohort) patients (median [interquartile] age 74 [72–78] years). Fifty-three percent, 31%, and 16% were 70–74, 75–79, and over 80 years old, respectively. The most frequent comorbidities were chronic hypertension (62%), diabetes (30%), and chronic respiratory disease (25%). Median Clinical Frailty Scale was 3 (2–3). Upon admission, the PaO 2 /FiO 2 ratio was 154 (105–222). 740 (62%) patients were intubated on Day-1 and eventually 938 (78%) during their ICU stay. Overall Day-90 mortality was 46% and reached 67% among the 193 patients over 80 years old. Mortality was higher in older patients, diabetics, and those with a lower PaO 2 /FiO 2 ratio upon admission, cardiovascular dysfunction, and a shorter time between first symptoms and ICU admission. In propensity analysis, early intubation at ICU admission was associated with a significantly higher Day-90 mortality (42% vs 28%; hazard ratio 1.68; 95% CI 1.24–2.27; p

Published
2021
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results