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1. Mechanical ventilation in patients with acute brain injury: a systematic review with meta-analysis

Author: Karim Asehnoune, Paul Rooze, Chiara Robba, Marwan Bouras, Luciana Mascia, Raphaël Cinotti, Paolo Pelosi, and Antoine Roquilly
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Objective To describe the potential effects of ventilatory strategies on the outcome of acute brain-injured patients undergoing invasive mechanical ventilation. Design Systematic review with an individual data meta-analysis. Setting Observational and interventional (before/after) studies published up to August 22nd, 2022, were considered for inclusion. We investigated the effects of low tidal volume Vt = 8 ml/Kg of IBW, positive end-expiratory pressure (PEEP) = 5 cmH2O and protective ventilation (association of both) on relevant clinical outcomes. Population Patients with acute brain injury (trauma or haemorrhagic stroke) with invasive mechanical ventilation for ≥ 24 h. Main outcome measures The primary outcome was mortality at 28 days or in-hospital mortality. Secondary outcomes were the incidence of acute respiratory distress syndrome (ARDS), the duration of mechanical ventilation and the partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio. Results The meta-analysis included eight studies with a total of 5639 patients. There was no difference in mortality between low and high tidal volume [Odds Ratio, OR 0.88 (95%Confidence Interval, CI 0.74 to 1.05), p = 0.16, I 2 = 20%], low and moderate to high PEEP [OR 0.8 (95% CI 0.59 to 1.07), p = 0.13, I 2 = 80%] or protective and non-protective ventilation [OR 1.03 (95% CI 0.93 to 1.15), p = 0.6, I 2 = 11]. Low tidal volume [OR 0.74 (95% CI 0.45 to 1.21, p = 0.23, I 2 = 88%], moderate PEEP [OR 0.98 (95% CI 0.76 to 1.26), p = 0.9, I 2 = 21%] or protective ventilation [OR 1.22 (95% CI 0.94 to 1.58), p = 0.13, I 2 = 22%] did not affect the incidence of acute respiratory distress syndrome. Protective ventilation improved the PaO2/FiO2 ratio in the first five days of mechanical ventilation (p
Published: 2023
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2. Prevalence and risk factors of significant persistent pain symptoms after critical care illness: a prospective multicentric study

Author: Alexandre Bourdiol, Vincent Legros, Fanny Vardon-Bounes, Thomas Rimmele, Paul Abraham, Clément Hoffmann, Claire Dahyot-Fizelier, Maud Jonas, Pierre Bouju, Cédric Cirenei, Yoann Launey, Gregoire Le Gac, Samia Boubeche, Edouard Lamarche, Olivier Huet, Lucillia Bezu, Julie Darrieussecq, Magdalena Szczot, Agathe Delbove, Johan Schmitt, Sigismond Lasocki, Johann Auchabie, Ludivine Petit, Emmanuelle Kuhn-Bougouin, Karim Asehnoune, Hugo Ingles, Antoine Roquilly, Raphaël Cinotti, the ALGO-RÉA study group, the Atlanréa Group, and the Société Française d’Anesthésie-Réanimation–SFAR Research Network
Subjects: Pain, Neuropathic pain, ID-pain, Critical care, Post-intensive care syndrome, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Prevalence, risk factors and medical management of persistent pain symptoms after critical care illness have not been thoroughly investigated. Methods We performed a prospective multicentric study in patients with an intensive care unit (ICU) length of stay ≥ 48 h. The primary outcome was the prevalence of significant persistent pain, defined as a numeric rating scale (NRS) ≥ 3, 3 months after admission. Secondary outcomes were the prevalence of symptoms compatible with neuropathic pain (ID-pain score > 3) and the risk factors of persistent pain. Results Eight hundred fourteen patients were included over a 10-month period in 26 centers. Patients had a mean age of 57 (± 17) years with a SAPS 2 score of 32 (± 16) (mean ± SD). The median ICU length of stay was 6 [4–12] days (median [interquartile]). At 3 months, the median intensity of pain symptoms was 2 [1–5] in the entire population, and 388 (47.7%) patients had significant pain. In this group, 34 (8.7%) patients had symptoms compatible with neuropathic pain. Female (Odds Ratio 1.5 95% CI [1.1–2.1]), prior use of anti-depressive agents (OR 2.2 95% CI [1.3–4]), prone positioning (OR 3 95% CI [1.4–6.4]) and the presence of pain symptoms on ICU discharge (NRS ≥ 3) (OR 2.4 95% CI [1.7–3.4]) were risk factors of persistent pain. Compared with sepsis, patients admitted for trauma (non neuro) (OR 3.5 95% CI [2.1–6]) were particularly at risk of persistent pain. Only 35 (11.3%) patients had specialist pain management by 3 months. Conclusions Persistent pain symptoms were frequent in critical illness survivors and specialized management remained infrequent. Innovative approaches must be developed in the ICU to minimize the consequences of pain. Trial registration. NCT04817696. Registered March 26, 2021.
Published: 2023
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3. Utilization of mechanical power and associations with clinical outcomes in brain injured patients: a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial

Author: Sarah Wahlster, Monisha Sharma, Shaurya Taran, James A. Town, Robert D. Stevens, Raphaël Cinotti, Karim Asehoune, Paolo Pelosi, Chiara Robba, and ENIO Study Group Collaborators
Subjects: Acute brain injury, Mechanical power, Acute respiratory distress syndrome, Mechanical ventilation, Traumatic brain injury, Subarachnoid hemorrhage, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background There is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes. Methods In this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required mechanical ventilation (MV) ≥ 24 h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS). Results We included 1217 patients (mean age 51.2 years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9 J/min [IQR 9.2–15.1], 13 J/min [IQR 10–17], and 14 J/min [IQR 11–20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9 J/min, aRR at 17 J/min was 1.22, 95% CI 1.14–1.30) and HD3 (1.38, 95% CI 1.23–1.53), reintubation on HD1 (1.64; 95% CI 1.57–1.72), and tracheostomy on HD7 (1.53; 95%CI 1.18–1.99). MP was associated with the development of moderate-severe ARDS on HD1 (2.07; 95% CI 1.56–2.78) and HD3 (1.76; 95% CI 1.41–2.22). Conclusions Exposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity. Potential benefits of optimizing ventilator settings to limit MP warrant further investigation.
Published: 2023
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4. Goal-Directed Fluid Therapy and major postoperative complications in elective craniotomy. A retrospective analysis of a before-after multicentric study

Author: Morgan Le Guen, Amandine Le Gall-Salaun, Julien Josserand, Augustin Gaudin de Vilaine, Simon Viquesnel, Damien Muller, Bertrand Rozec, Kévin Buffenoir Billet, Raphaël Cinotti, and the Société Française d’Anesthésie-Réanimation–SFAR Research Network
Subjects: Craniotomy, Goal directed fluid therapy, Outcome, Postoperative complications, Anesthesiology, RD78.3-87.3
Abstract: Abstract Background Goal-Directed Fluid Therapy (GDFT) is recommended to decrease major postoperative complications. However, data are lacking in intra-cranial neurosurgery. Methods We evaluated the efficacy of a GDFT protocol in a before/after multi-centre study in patients undergoing elective intra-cranial surgery for brain tumour. Data were collected during 6 months in each period (before/after). GDFT was performed in high-risk patients: ASA score III/IV and/or preoperative Glasgow Coma Score (GCS)
Published: 2023
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5. Association between in-ICU red blood cells transfusion and 1-year mortality in ICU survivors

Author: Alice Blet, Joel B. McNeil, Julie Josse, Bernard Cholley, Raphaël Cinotti, Gad Cotter, Agnès Dauvergne, Beth Davison, Kévin Duarte, Jacques Duranteau, Marie-Céline Fournier, Etienne Gayat, Samir Jaber, Sigismond Lasocki, Thomas Merkling, Katell Peoc’h, Imke Mayer, Malha Sadoune, Pierre-François Laterre, Romain Sonneville, Lorraine Ware, Alexandre Mebazaa, and Antoine Kimmoun
Subjects: Transfusion, Mortality, Critical care unit, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Impact of in-ICU transfusion on long-term outcomes remains unknown. The purpose of this study was to assess in critical-care survivors the association between in-ICU red blood cells transfusion and 1-year mortality. Methods FROG-ICU, a multicenter European study enrolling all-comers critical care patients was analyzed (n = 1551). Association between red blood cells transfusion administered in intensive care unit and 1-year mortality in critical care survivors was analyzed using an augmented inverse probability of treatment weighting-augmented inverse probability of censoring weighting method to control confounders. Results Among the 1551 ICU-survivors, 42% received at least one unit of red blood cells while in intensive care unit. Patients in the transfusion group had greater severity scores than those in the no-transfusion group. According to unweighted analysis, 1-year post-critical care mortality was greater in the transfusion group compared to the no-transfusion group (hazard ratio (HR) 1.78, 95% CI 1.45–2.16). Weighted analyses including 40 confounders, showed that transfusion remained associated with a higher risk of long-term mortality (HR 1.21, 95% CI 1.06–1.46). Conclusions Our results suggest a high incidence of in-ICU RBC transfusion and that in-ICU transfusion is associated with a higher 1-year mortality among in-ICU survivors. Trial registration ( NCT01367093 ; Registered 6 June 2011). Graphic Abstract
Published: 2022
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6. Development of a core outcome set for ventilation trials in neurocritical care patients with acute brain injury: protocol for a Delphi consensus study of international stakeholders

Author: Chiara Robba, Romain Pirracchio, Raphaël Cinotti, Nicholas Fong, Jean Digitale, Gregory Burns, Julian Boesel, and Robert D Stevens
Subjects: Medicine
Abstract: Introduction There is little consensus and high heterogeneity on the optimal set of relevant clinical outcomes in research studies regarding extubation in neurocritical care patients with brain injury undergoing mechanical ventilation. The aims of this study are to: (1) develop a core outcome set (COS) and (2) reach consensus on a hierarchical composite endpoint for such studies.Methods and analysis The study will include a broadly representative, international panel of stakeholders with research and clinical expertise in this field and will involve four stages: (1) a scoping review to generate an initial list of outcomes represented in the literature, (2) an investigator meeting to review the outcomes for inclusion in the Delphi surveys, (3) four rounds of online Delphi consensus-building surveys and (4) online consensus meetings to finalise the COS and hierarchical composite endpoint.Ethics and dissemination This study received ethical approval from the French Society of Anesthesia and Critical Care Medicine Institutional Review Board (SFAR CERAR-IRB 00010254‐2023-029). The study results will be disseminated through communication to stakeholders, publication in a peer-reviewed journal, and presentations at conferences.Trial registration number This study is registered with the Core Outcome Measures in Effectiveness Trials (COMET) Initiative.
Published: 2023
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7. Complications and risk factors on midline catheters’ follow-up about non-ICU patients: study protocol for a multicentre observational study (the midDATA study)

Author: Aurélie Le Thuaut, Raphaël Cinotti, Yvan Derouin, Jérome Dauvergne, and Emmanuelle Cartron
Subjects: Medicine
Abstract: Introduction The midline catheter (MC) is an increasingly popular device used commonly for patients with difficult venous access or those who require infusion for more than 6 days. Little is known about complications such as infection, thrombosis or occlusion for inpatient and home care patient. This protocol presents the follow-up of non-intensive care unit patients with an MC. The aim is to identify complications and search for risk factors associated with these complications.Method and analysis A prospective observational design is used for the follow-up of 2000 patients from 13 centres in France. Each practitioner (inserting clinician, anaesthetist nurse, hospital nurse and home nurse) will fill out a logbook to report each care made (eg, number of saline flushes, dress maintenance) on the MC and if any complications occurred. The incidence of complications (ie, infections, thrombosis or occlusions) will be expressed by the total number of events per 1000 catheter days. The period of recruitment began in December 2019 for a duration of 2 years. An extension of the inclusion period of 1 year was obtained.Ethics and dissemination This study received the approval of the Committee for the Protection of Persons of Nord Ouest IV (No EudraCT/ID-RCB : 2019-A02406-51). It was registered at clinical trials (NCT04131088). It is planned to communicate results at conferences and in a peer-reviewed journal.Trial registration number NCT04131088.
Published: 2023
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8. Association of preoperative COVID-19 and postoperative respiratory morbidity during the Omicron epidemic wave: the DROMIS-22 multicentre prospective observational cohort studyResearch in context

Author: Marc Garnier, Jean-Michel Constantin, Raphaël Cinotti, Chafia Daoui, Dimitri Margetis, Grégory Destruhaut, Cédric Cirenei, Eric Noll, Christophe Quesnel, Agnes Lecinq, Sigismond Lasocki, Hélène Charbonneau, Stanislas Abrard, Cyril Quemeneur, Bruno Pastene, Nathanaël Lapidus, Marc Leone, El Mahdi Hafiani, Olivier Imauven, Emmanuel Rineau, Maxime Léger, Marc Danguy des Deserts, Johan Schmitt, Philippe Aries, Aurélie Gouel, Julia Voulgaropoulos, Laura Soldan, Romain Deransy, Quentin Laurent, Etienne Gayat, Franck Verdonk, Sabrina Chaouche, Amélie Cambriel, Vincent Degos, Julie Dupont, Laura Daoud, Romain Salettes, Malory Favreau, Julien Pottecher, Sophie Diemunsch, Cyril Bidon, Clémence Roy, Laëtitia Ottolenghi, Damien Edouard, Agnès Lecinq, Frédéric Mercier, Delphine Garrigue, Elsa Jozefowicz, Marie Pariès, Fabien Espitalier, Charlène Piat, Richard Descamps, Maëlle Duchesne, Stéphanie Sigaut, Laurie-Anne Thion, Julie Renard, Elsa Brocas, Besma Zbidi, Mohamed Fki, Guillaume Dufour, Mario Bucciero, Charles-Edouard Rochon, Céline Delerue, Virginie Trehel-Tursis, Julien Raft, Olivier Rangeard, Claire Thiriet, Kevin Lagarde, Angélina Pollet, Félix Pelen, Anaïs Caillard, Philippe Penven, Olivier Huet, Floriane Puel, Xavier Pichon, Laetitia Ligneres, Pauline Bleuze, Stéphanie Deryckere, Lionel Velly, Pierre Simeone, Hery Andrianjatovo, Youri Chipouline, Mouna Boolad, Denis Frasca, Quentin Plouviez, Benoit Plaud, Eric Roland, Delphine Cheron-Leroy, Samy Figueiredo, Antonia Blanié, Olivier Joannes-Boyau, Simon Monziols, Jean-Jacques Robin, Matthieu Biais, Hugues De Courson, Cécile Degryse, Marie Do-Khac, Marie-Pierre Bonnet, Aurélien Mazeraud, Jean Bardon, Eléonore Bouchereau, Karine Bezulier, Ségolène Mrozek, Nicolas Mayeur, and Sandrine Lopez
Subjects: COVID-19, Anaesthesia, Surgery, Perioperative risk, Respiratory complications, Postoperative pneumonia, Medicine (General), R5-920
Abstract: Summary: Background: Preoperative COVID-19 has been associated with excess postoperative morbi-mortality. Consequently, guidelines were developed that recommended the postponement of surgery for at least 7 weeks after the infection. We hypothesised that vaccination against the SARS-CoV-2 and the large predominance of the Omicron variant attenuated the effect of a preoperative COVID-19 on the occurrence of postoperative respiratory morbidity. Methods: We conducted a prospective cohort study in 41 French centres between 15 March and 30 May 2022 (ClinicalTrials NCT05336110), aimed at comparing the postoperative respiratory morbidity between patients with and without preoperative COVID-19 within 8 weeks prior to surgery. The primary outcome was a composite outcome combining the occurrence of pneumonia, acute respiratory failure, unexpected mechanical ventilation, and pulmonary embolism within the first 30 postoperative days. Secondary outcomes were 30-day mortality, hospital length-of-stay, readmissions, and non-respiratory infections. The sample size was determined to have 90% power to identify a doubling of the primary outcome rate. Adjusted analyses were performed using propensity score modelling and inverse probability weighting. Findings: Of the 4928 patients assessed for the primary outcome, of whom 92.4% were vaccinated against the SARS-CoV-2, 705 had preoperative COVID-19. The primary outcome was reported in 140 (2.8%) patients. An 8-week preoperative COVID-19 was not associated with increased postoperative respiratory morbidity (odds ratio 1.08 [95% CI 0.48–2.13]; p = 0.83). None of the secondary outcomes differed between the two groups. Sensitivity analyses concerning the timing between COVID-19 and surgery, and the clinical presentations of preoperative COVID-19 did not show any association with the primary outcome, except for COVID-19 patients with ongoing symptoms the day of surgery (OR 4.29 [1.02–15.8]; p = 0.04). Interpretation: In our Omicron-predominant, highly immunised population undergoing general surgery, a preoperative COVID-19 was not associated with increased postoperative respiratory morbidity. Funding: The study was fully funded by the French Society of Anaesthesiology and Intensive Care Medicine (SFAR).
Published: 2023
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9. Readmission following both cardiac and non‐cardiac acute dyspnoea is associated with a striking risk of death

Author: Kamilė Čerlinskaitė, Alexandre Mebazaa, Raphaël Cinotti, Michael Matthay, Desiree N. Wussler, Etienne Gayat, Vytautas Juknevičius, Nikola Kozhuharov, Julia Dinort, Eleni Michou, Danielle M. Gualandro, Eglė Palevičiūtė, Irina Alitoit‐Marrote, Denis Kablučko, Loreta Bagdonaitė, Mindaugas Balčiūnas, Dovilė Vaičiulienė, Ieva Jonauskienė, Justina Motiejūnaitė, Kęstutis Stašaitis, Audrys Kukulskis, Šarūnas Damalakas, Aleksandras Laucevičius, Christian Mueller, Aušra Kavoliūnienė, Jelena Čelutkienė, and GREAT network
Subjects: Acute dyspnoea, Emergency department, Vulnerable phase, Acute heart failure, Mortality, Readmission, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Abstract Aims Readmission and mortality are the most common and often combined endpoints in acute heart failure (AHF) trials, but an association between these two outcomes is poorly investigated. The aim of this study was to determine whether unplanned readmission is associated with a greater subsequent risk of death in patients with acute dyspnoea due to cardiac and non‐cardiac causes. Methods and results Derivation cohort (1371 patients from the LEDA study) and validation cohort (1986 patients from the BASEL V study) included acute dyspnoea patients admitted to the emergency department. Cox regression analysis was used to determine the association of 6 month readmission and the risk of 1 year all‐cause mortality in AHF and non‐AHF patients and those readmitted due to cardiovascular and non‐cardiovascular causes. In the derivation cohort, 666 (49%) of patients were readmitted at 6 months and 282 (21%) died within 1 year. Six month readmission was associated with an increased 1 year mortality risk in both the derivation cohort [adjusted hazard ratio (aHR) 3.0 (95% confidence interval, CI 2.2–4.0), P
Published: 2021
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10. Diuretics decrease fluid balance in patients on invasive mechanical ventilation: the randomized-controlled single blind, IRIHS study

Author: Raphaël Cinotti, Jean-Baptiste Lascarrou, Marie-Ange Azais, Gwenhaël Colin, Jean-Pierre Quenot, Pierre-Joachim Mahé, Antoine Roquilly, Aurélie Gaultier, Karim Asehnoune, and Jean Reignier
Subjects: Fluid balance, Diuretic, Mechanical ventilation, Weaning, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Fluid overload has been associated with increased morbidity and mortality in critically ill patients. The goal of this study was to assess the efficacy and safety of a diuretic strategy to overcome positive fluid balance in patients on invasive mechanical ventilation. Methods Design: Multicenter, single-blind, randomized-controlled study. Patients were randomized into a diuretic (furosemide) or a control group. Patients were eligible in case of fluid overload defined as in-ICU weight increase ≥ 3%, invasive mechanical ventilation (FiO2 ≤ 60% and PEEP ≤ 10 cm H2O on inclusion) and hemodynamic stabilization. The primary outcome was fluid balance, defined as weight variation from reference weight to successful extubation. The main secondary outcome was the safety of diuretic. Results 171 patients were randomized. After 5 exclusions, 166 patients were included in the analysis: 77 in the diuretic and 89 in the control group. Fluid balance was 1.4 [− 2.5 to 4.5] kg in the diuretic and 6.4 [0.5–11.2] kg in the control group (p
Published: 2021
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11. Potential Impact of Rapid Multiplex PCR on Antimicrobial Therapy Guidance for Ventilated Hospital-Acquired Pneumonia in Critically Ill Patients, A Prospective Observational Clinical and Economic Study

Author: Florian Guillotin, Cécile Poulain, Benjamin Gaborit, Marwan Bouras, Raphaël Cinotti, Karim Lakhal, Mickael Vourc’h, Bertrand Rozec, Karim Asehnoune, Marie-Anne Vibet, Valéry-Pierre Riche, Sophie-Anne Gibaud, Lise Crémet, and Antoine Roquilly
Subjects: pneumonia, biomolecular diagnosis, empiric treatment, intensive care unit, hospital-acquired pneumonia, Microbiology, QR1-502
Abstract: ObjectivesTo investigate the potential impact of the syndromic multiplex FilmArray® Pneumonia plus Panel (FAPP) on the antimicrobial treatment guidance of patients with ventilated hospital-acquired pneumonia (VHAP).MethodsRespiratory fluids from 100 adult patients with VHAP, receiving invasive mechanical ventilation in three intensive care units from one French university hospital, were tested prospectively using FAPP. Conventional cultures were performed in parallel as routine practice. Clinicians were left blinded to the FAPP results. Antimicrobial therapies based on FAPP results were simulated by independent blinded experts according to a predefined algorithm and compared to 1) those prescribed in practice according to local guidelines (real-life), and 2) those that complied with the international ERS/ESICM/ESCMID/ALAT recommendations. The primary endpoint was the number of days of broad-spectrum antimicrobial therapy. Secondary endpoints were the rates of microbiological treatment failure and cost-effectiveness ratio.ResultsThe predicted median duration of broad-spectrum antibiotics was 0 [0-1.25] day in the FAPP-based simulation, versus 2 [0-6] days in real-life (p
Published: 2022
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12. Improved cardiac and venous pressures during hospital stay in patients with acute heart failure: an echocardiography and biomarkers study

Author: Eiichi Akiyama, Raphaël Cinotti, Kamilė Čerlinskaitė, Lucas N.L. Van Aelst, Mattia Arrigo, Rui Placido, Tahar Chouihed, Nicolas Girerd, Faiez Zannad, Patrick Rossignol, Marc Badoz, Jean‐Marie Launay, Etienne Gayat, Alain Cohen‐Solal, Carolyn S.P. Lam, Jeffrey Testani, Wilfried Mullens, Gad Cotter, Marie‐France Seronde, and Alexandre Mebazaa
Subjects: Acute heart failure, Congestion, Biomarker, Echocardiography, Heart failure with preserved ejection fraction, Heart failure with reduced ejection fraction, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Abstract Aims Changes in echocardiographic parameters and biomarkers of cardiac and venous pressures or estimated plasma volume during hospitalization associated with decongestive treatments in acute heart failure (AHF) patients with either preserved left ventricular ejection fraction (LVEF) (HFPEF) or reduced LVEF (HFREF) are poorly assessed. Methods and results From the metabolic road to diastolic heart failure: diastolic heart failure (MEDIA‐DHF) study, 111 patients were included in this substudy: 77 AHF (43 HFPEF and 34 HFREF) and 34 non‐cardiac dyspnea patients. Echocardiographic measurements and blood samples were obtained within 4 h of presentation at the emergency department and before hospital discharge. In AHF patients, echocardiographic indices of cardiac and venous pressures, including inferior vena cava diameter [from 22 (16–24) mm to 13 (11–18) mm, P = 0.009], its respiratory variability [from 32 (8–44) % to 43 (29–70) %, P = 0.04], medial E/e' [from 21.1 (15.8–29.6) to 16.6 (11.7–24.3), P = 0.004], and E wave deceleration time [from 129 (105–156) ms to 166 (128–203) ms, P = 0.003], improved during hospitalization, similarly in HFPEF and HFREF patients. By contrast, no changes were seen in non‐cardiac dyspnea patients. In AHF patients, all plasma biomarkers of cardiac and venous pressures, namely B‐type natriuretic peptide [from 935 (514–2037) pg/mL to 308 (183–609) pg/mL, P < 0.001], mid‐regional pro‐atrial natriuretic peptide [from 449 (274–653) pmol/L to 366 (242–549) pmol/L, P < 0.001], and soluble CD‐146 levels [from 528 (406–654) ng/mL to 450 (374–529) ng/mL, P = 0.003], significantly decreased during hospitalization, similarly in HFPEF and HFREF patients. Echocardiographic parameters of cardiac chamber dimensions [left ventricular end‐diastolic volume: from 120 (76–140) mL to 118 (95–176) mL, P = 0.23] and cardiac index [from 2.1 (1.6–2.6) mL/min/m2 to 1.9 (1.4–2.4) mL/min/m2, P = 0.55] were unchanged in AHF patients, except tricuspid annular plane systolic excursion (TAPSE) that improved during hospitalization [from 16 (15–19) mm to 19 (17–21) mm, P = 0.04]. Estimated plasma volume increased in both AHF [from 4.8 (4.2–5.6) to 5.1 (4.4–5.8), P = 0.03] and non‐cardiac dyspnea patients (P = 0.01). Serum creatinine [from 1.18 (0.90–1.53) to 1.19 (0.86–1.70) mg/dL, P = 0.89] and creatinine‐based estimated glomerular filtration rate [from 59 (40–75) mL/min/1.73m2 to 56 (38–73) mL/min/1.73m2, P = 0.09] were similar, while plasma cystatin C [from 1.50 (1.20–2.27) mg/L to 1.78 (1.33–2.59) mg/L, P < 0.001] and neutrophil gelatinase associated lipocalin (NGAL) [from 127 (95–260) ng/mL to 167 (104–263) ng/mL, P = 0.004] increased during hospitalization in AHF. Conclusions Echocardiographic parameters and plasma biomarkers of cardiac and venous pressures improved during AHF hospitalization in both acute HFPEF and HFREF patients, while cardiac chamber dimensions, cardiac output, and estimated plasma volume showed minimal changes.
Published: 2020
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13. Early use of barbiturates is associated with increased mortality in traumatic brain injury patients from a propensity score-based analysis of a prospective cohort.

Author: Maxime Léger, Denis Frasca, Antoine Roquilly, Philippe Seguin, Raphaël Cinotti, Claire Dahyot-Fizelier, Karim Asehnoune, Florent Le Borgne, Thomas Gaillard, Yohann Foucher, Sigismond Lasocki, and for AtlanRéa group
Subjects: Medicine, Science
Abstract: Barbiturates are proposed as a second/third line treatment for intracranial hypertension in traumatic brain injury (TBI) patients, but the literature remains uncertain regarding their benefit/risk balance. We aimed to evaluate the impact of barbiturates therapy in TBI patients with early intracranial hypertension on the intensive care unit (ICU) survival, the occurrence of ventilator-associated pneumonia (VAP), and the patient's functional status at three months. We used the French AtlanREA prospective cohort of trauma patients. Using a propensity score-based methodology (inverse probability of treatment weighting), we compared patients having received barbiturates within the first 24 hours of admission (barbiturates group) and those who did not (control group). We used cause-specific Cox models for ICU survival and risk of VAP, and logistic regression for the 3-month Glasgow Outcome Scale (GOS) evaluation. Among the 1396 patients with severe trauma, 383 had intracranial hypertension on admission and were analyzed. Among them, 96 (25.1%) received barbiturates. The early use of barbiturates was significantly associated with increased ICU mortality (HR = 1.85, 95%CI 1.03-3.33). However, barbiturates treatment was not significantly associated with VAP (HR = 1.02, 95%CI 0.75-1.41) or 3-month GOS (OR = 1.67, 95%CI 0.84-3.33). Regarding the absence of relevant clinical trials, our results suggest that each early prescription of barbiturates requires a careful assessment of the benefit/risk ratio.
Published: 2022
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14. Methodological quality of multivariate prognostic models for intracranial haemorrhages in intensive care units: a systematic review

Author: Denis Frasca, Fanny Feuillet, Maxime Leger, Raphaël Cinotti, Yohann Foucher, Jeanne Simon-Pimmel, Laetitia Bodet-Contentin, and Etienne Dantan
Subjects: Medicine
Abstract: Objectives Patients with severe spontaneous intracranial haemorrhages, managed in intensive care units, face ethical issues regarding the difficulty of anticipating their recovery. Prognostic tools help clinicians in counselling patients and relatives and guide therapeutic decisions. We aimed to methodologically assess prognostic tools for functional outcomes in severe spontaneous intracranial haemorrhages.Data sources Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations, we conducted a systematic review querying Medline, Embase, Web of Science, and the Cochrane in January 2020.Study selection We included development or validation of multivariate prognostic models for severe intracerebral or subarachnoid haemorrhage.Data extraction We evaluated the articles following the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies and Transparent Reporting of multivariable prediction model for Individual Prognosis Or Diagnosis statements to assess the tools’ methodological reporting.Results Of the 6149 references retrieved, we identified 85 articles eligible. We discarded 43 articles due to the absence of prognostic performance or predictor selection. Among the 42 articles included, 22 did not validate models, 6 developed and validated models and 14 only externally validated models. When adding 11 articles comparing developed models to existing ones, 25 articles externally validated models. We identified methodological pitfalls, notably the lack of adequate validations or insufficient performance levels. We finally retained three scores predicting mortality and unfavourable outcomes: the IntraCerebral Haemorrhages (ICH) score and the max-ICH score for intracerebral haemorrhages, the SubArachnoid Haemorrhage International Trialists score for subarachnoid haemorrhages.Conclusions Although prognostic studies on intracranial haemorrhages abound in the literature, they lack methodological robustness or show incomplete reporting. Rather than developing new scores, future authors should focus on externally validating and updating existing scores with large and recent cohorts.
Published: 2021
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15. Multicentre observational study on practice of ventilation in brain injured patients: the VENTIBRAIN study protocol

Author: Raimund Helbok, Karim Asehnoune, Giuseppe Citerio, Geert Meyfroidt, Nino Stocchetti, Chiara Robba, Alessia Vargiolu, Jordi Mancebo, Christian Putensen, Rafael Badenes, John Laffey, Robert Stevens, Paolo Pelosi, Raphaël Cinotti, Stefania Galimberti, Paola Rebora, Fabio S Taccone, Maura Mandelli, Valentina Della Torre, Jose’ Suarez, Marcelo Gama De Abreu, Marcus Schultz, and Louis Blanch
Subjects: Medicine
Abstract: Introduction Mechanical ventilatory is a crucial element of acute brain injured patients’ management. The ventilatory goals to ensure lung protection during acute respiratory failure may not be adequate in case of concomitant brain injury. Therefore, there are limited data from which physicians can draw conclusions regarding optimal ventilator management in this setting.Methods and analysis This is an international multicentre prospective observational cohort study. The aim of the ‘multicentre observational study on practice of ventilation in brain injured patients’—the VENTIBRAIN study—is to describe the current practice of ventilator settings and mechanical ventilation in acute brain injured patients. Secondary objectives include the description of ventilator settings among different countries, and their association with outcomes. Inclusion criteria will be adult patients admitted to the intensive care unit (ICU) with a diagnosis of traumatic brain injury or cerebrovascular diseases (intracranial haemorrhage, subarachnoid haemorrhage, ischaemic stroke), requiring intubation and mechanical ventilation and admission to the ICU. Exclusion criteria will be the following: patients aged
Published: 2021
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16. A longitudinal cohort of stress cardiomyopathy assessed with speckle-tracking echocardiography after moderate to severe traumatic brain injury

Author: Raphaël Cinotti, Thierry Le Tourneau, Kalyane Bach-Ngohou, Maxime Le Courtois du Manoir, Bertrand Rozec, and Karim Asehnoune
Subjects: Stress cardiomyopathy, Traumatic brain injury, Speckle-tracking echocardiography, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Published: 2020
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17. Cortisol total/CRP ratio for the prediction of hospital-acquired pneumonia and initiation of corticosteroid therapy in traumatic brain-injured patients

Author: Marwan Bouras, Antoine Roquilly, Pierre-Joachim Mahé, Raphaël Cinotti, Mickaël Vourc’h, Bastien Perrot, Kalyane Bach-Ngohou, Damien Masson, and Karim Asehnoune
Subjects: Traumatic, Brain, Injury, Pneumonia, Cortisol, CRP, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background To propose a combination of blood biomarkers for the prediction of hospital-acquired pneumonia (HAP) and for the selection of traumatic brain-injured (TBI) patients eligible for corticosteroid therapy for the prevention of HAP. Methods This was a sub-study of the CORTI-TC trial, a multicenter, randomized, double-blind, controlled trial evaluating the risk of HAP at day 28 in 336 TBI patients treated or not with corticosteroid therapy. Patients were between 15 and 65 years with severe traumatic brain injury (Glasgow coma scale score ≤ 8 and trauma-associated lesion on brain CT scan) and were enrolled within 24 h of trauma. The blood levels of CRP and cortisoltotal&free, as a surrogate marker of the pro/anti-inflammatory response balance, were measured in samples collected before the treatment initiation. Endpoint was HAP on day 28. Results Of the 179 patients with available samples, 89 (49.7%) developed an HAP. Cortisoltotal&free and CRP blood levels upon ICU admission were not significantly different between patients with or without HAP. The cortisoltotal/CRP ratio upon admission was 2.30 [1.25–3.91] in patients without HAP and 3.36 [1.74–5.09] in patients with HAP (p = 0.021). In multivariate analysis, a cortisoltotal/CRP ratio > 3, selected upon the best Youden index on the ROC curve, was independently associated with HAP (OR 2.50, CI95% [1.34–4.64] p = 0.004). The HR for HAP with corticosteroid treatment was 0.59 (CI95% [0.34–1.00], p = 0.005) in patients with a cortisoltotal/CRP ratio > 3, and 0.89 (CI95% [0.49–1.64], p = 0.85) in patients with a ratio 3 upon admission may predict the development of HAP in severe TBI. Among these patients, corticosteroids reduce the occurrence HAP. We suggest that this ratio may select the patients who may benefit from corticosteroid therapy for the prevention of HAP.
Published: 2019
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18. Respiratory Management in Patients with Severe Brain Injury

Author: Karim Asehnoune, Antoine Roquilly, and Raphaël Cinotti
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2018. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2018. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
Published: 2018
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19. Tracheostomy and long-term mortality in ICU patients undergoing prolonged mechanical ventilation.

Author: Raphaël Cinotti, Sebastian Voicu, Samir Jaber, Benjamin Chousterman, Catherine Paugam-Burtz, Haikel Oueslati, Charles Damoisel, Anaïs Caillard, Antoine Roquilly, Fanny Feuillet, Alexandre Mebazaa, Etienne Gayat, and FROG-ICU investigators
Subjects: Medicine, Science
Abstract: INTRODUCTION:In critically ill patients undergoing prolonged mechanical ventilation (MV), the difference in long-term outcomes between patients with or without tracheostomy remains unexplored. METHODS:Ancillary study of a prospective international multicentre observational cohort in 21 centres in France and Belgium, including 2087 patients, with a one-year follow-up after admission. We included patients with a MV duration ≥10 days, with or without tracheostomy. We explored the one-year mortality with a classical Cox regression model (adjustment on age, SAPS II, baseline diagnosis and withdrawal of life-sustaining therapies) and a Cox regression model using tracheostomy as a time-dependant variable. RESULTS:29.5% patients underwent prolonged MV, out of which 25.6% received tracheostomy and 74.4% did not. At one-year, 45.2% patients had died in the tracheostomy group and 51.5% patients had died in the group without tracheostomy (p = 0.001). In the Cox-adjusted regression model, tracheostomy was not associated with improved one-year outcome (HR CI95 0.7 [0.5-1.001], p = 0.051), as well as in the model using tracheostomy as a time-dependent variable (OR CI 95 1 [0.7-1.4], p = 0.9). CONCLUSIONS:In our study, there was no statistically significant difference in the one-year mortality of patients undergoing prolonged MV when receiving tracheostomy or not. TRIAL REGISTRATION:NCT01367093.
Published: 2019
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20. Hydrocortisone plus fludrocortisone for community acquired pneumonia-related septic shock: a subgroup analysis of the APROCCHSS phase 3 randomised trial

Author: Djillali, ANNANE, Christian, BRUN-BUISSON, Benoit, MISSET, Jean, CHASTRE, François, BRIVET, Julien, BOHE, Carole, SCHWEBEL, Shidasp, SIAMI, Michel, SLAMA, Olivier, LEROY, Gilles, CAPELLIER, Michel, WOLFF, Mohamed, ALI BEN ALI, François, ANTONINI, Jean-François, LORIFERNE, Franck, PETITPAS, Claire, CHARPENTIER, Jean-Michel, CONSTANTIN, Gilles, D'HONNEUR, Bertrand, SOUWEINE, Xavier, FORCEVILLE, Bruno, MEGARBANE, Francois, BAUDIN, Gwenhaël, COLIN, Karim, ASEHNOUNE, Jean-Pierre, QUENOT, Bruno, FRANCOIS, Thierry, BOULAIN, Emmanuelle, MERCIER, Jean, REIGNIER, Roland, AMATHIEU, Fabrice, COOK, Alain, CARIOU, Loic, CHIMOT, Fouad, Fadel, Andrea, Polito, Bernard, Clair, Virginie, Maxime, David, Luis, Tarek, Sharshar, David, Orlikowski, Keyvan, RAZAZI, Nicolas, DE PROST, Guillaume, CARTEAUX, Maité, GARROUSTE ORGEAS, François, Philippart, Alain, Combes, Ania, Nieszkowska, Frederic, Jacobs, Dominique, Prat, Patrick, Lafforgue, Claire, ARA SOMOHANO, Clémence, MINET, Maxime, LUGOSI, Julien, Maizel, Jean Christophe, Navellou, Bruno, Mourvillier, Lila, Bouadma, Jean François, Timsit, Claude Denis, Martin, Julien, Textoris, Sandrine, Wiramus, Clément, BRUN, Benoît, RAGONNET, Ali, Ait-Hssain, Samia, Touati, Jean, Kuba, Vincent, Willems, Pierre, Lahillaire, Mohammed, Lassi, Marion, ANTONA, Alia, MEGHENEM, Marine, DEMESMAY, Eric, Boulet, Olivier, LOUTREL, Romain, DUMONT, Antoine, ROQUILLY, Pierre-Joachim, MAHE, Dominique, DEMEURE dit LATTE, Philippe, CHAMPIN, Jean François, ARNOULD, Raphaël, CINOTTI, Ronan, Le FLOCH, Marc, Clavel, Philippe, Vignon, Nicolas, Pichon, Emmanuelle, BEGOT, Anne-Laure, FEDOU, Catherine, CHAPELLAS, Antoine, GALY, Dalila, Benzekri Lefevre, Armelle, Mathonnet, Anne, Bretagnol, Isabelle, Runge, François, BARBIER, Grégoire, MULLER, Denis, GAROT, Pierre François, DEQUIN, Dominique, PERROTIN, Annick, LEGRAS, Julie, MANKIKIAN, Patrice, TALEC, Stephan, EHRMANN, Aurélie, JORET, Claire, LHOMMET, Emmanuelle, ROUVE, Laetitia, BODET-CONTENTIN, Youenn, JOUAN, Charlotte, SALMONGANDONNIERE, Laurent, MARTIN-LEFEVRE, Matthieu, HENRY-LAGARRIGUE, Aihem, YEHIA, Jean-Baptiste, LASCARROU, Christine, LEBERT, Jean-Claude, LACHERADE, Eric, LEVESQUE, Yen-Lan, NGUYEN, Fabrice, DAVIAUD, Adrien, BOUGLE, Jean Paul, MIRA, Jean Daniel, CHICHE, Frederic, PENE, Tristan, MORICHAU-BEAUCHANT, Guillaume, GERI, Pierre Henri, DESSALLES, Yannick, MONSEAU, Mélanie, SAINT-LEGER, Sandrine, BEDON-CARTE, Laetitia, Bodet-Contentin, Walid, Darwiche, Stephan, Ehrmann, Denis, Garot, Antoine, Guillon, Youenn, Jouan, Annick, Legras, Julie, Mankikian, Emmanuelle, Mercier, Marlene, Morisseau, Yonatan, Perez, Emmanuelle, Rouve, Charlotte, Salmon-Gandonniere, Julie, Helms, Hassene, Rahmani, Alexandra, Monnier, Hamid, Merdji, Raphael, Clere-Jehl, Laure, Stiel, Antoine, Studer, Pascal, Andreu, Jean-Baptiste, Roudaut, Marie, Labruyere, Marine, Jacquier, Francois, Barbier, Dalila, Benzekri, Thierry, Boulain, Sophie, Jacquier, Gregoire, Muller, Mai-Anh, Nai, Sophie, Tollec, Damien, Roux, Jonathan, Messika, Constance, Vuillard, Louis-Marie, Dumont, Laura, Federici, Noemie, Zucman, Marc, Amouretti, Djillali, Annane, Pierre, Moine, Paris, Meng, Rania, Bounab, Muriel-Sarah, Fartoukh, Michel, Djibre, Alexandre, Elabbadi, Marie-Ange, Azais, Konstantinos, Bachoumas, Arthur, Bailly, Remi, Bernardon, Gauthier, Blonz, Luc, Desmedt, Brian, Emonet, Maud, Fiancette, Matthieu, Henry, Jean-Claude, Lacherade, Jean-Baptiste, Lascarrou, Christine, Lebert, Julien, Lorber, Laurent Martin-, Lefevre, Caroline, Pouplet, Isabelle, Vinatier, Aihem, Yehia, Sarah, Benghanem, Julien, Charpentier, Clara, Vigneron, Anne-Laure, Fedou, Claire, Mancia, Emmanuelle, Begot, Thomas, Daix, Antoine, Galy, Celine, Gonzalez, Marine, Goudelin, Bruno, Evrard, Arnaud, Desachy, Julien, Vaidie, Guillaume, Gilbert, Cedric, Darreau, Benoit, Derrien, Marjorie, Saint-Martin, Patrice, Tirot, Mickael, Landais, Nicolas, Chudeau, Jean Christophe, Callahan, Dominique, Vivier, Charlene, Le Moal, Pierre-Yves, Olivier, Remy, Marnai, Francis, Schneider, Nicolas, Sedillot, Xavier, Tchenio, Adrien, Robine, Yves, Poncelin, Remi, Bruyere, Heming, Nicholas, Renault, Alain, Kuperminc, Emmanuelle, Brun-Buisson, Christian, Megarbane, Bruno, Quenot, Jean-Pierre, Siami, Shidasp, Cariou, Alain, Forceville, Xavier, Schwebel, Carole, Leone, Marc, Timsit, Jean-Francois, Misset, Benoît, Benali, Mohamed Ali, Colin, Gwenhael, Souweine, Bertrand, Asehnoune, Karim, Mercier, Emmanuelle, Chimot, Loïc, Charpentier, Claire, François, Bruno, Boulain, Thierry, Petitpas, Frank, Constantin, Jean Michel, Dhonneur, Gilles, Baudin, François, Combes, Alain, Bohé, Julien, Loriferne, Jean-François, Cook, Fabrice, Slama, Michel, Leroy, Olivier, Capellier, Gilles, Dargent, Auguste, Hissem, Tarik, Bounab, Rania, Maxime, Virginie, Moine, Pierre, Bellissant, Eric, and Annane, Djillali
Published: 2024
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21. Hydrocortisone plus fludrocortisone for community acquired pneumonia-related septic shock: a subgroup analysis of the APROCCHSS phase 3 randomised trial

Author: Heming, Nicholas, primary, Renault, Alain, additional, Kuperminc, Emmanuelle, additional, Brun-Buisson, Christian, additional, Megarbane, Bruno, additional, Quenot, Jean-Pierre, additional, Siami, Shidasp, additional, Cariou, Alain, additional, Forceville, Xavier, additional, Schwebel, Carole, additional, Leone, Marc, additional, Timsit, Jean-Francois, additional, Misset, Benoît, additional, Benali, Mohamed Ali, additional, Colin, Gwenhael, additional, Souweine, Bertrand, additional, Asehnoune, Karim, additional, Mercier, Emmanuelle, additional, Chimot, Loïc, additional, Charpentier, Claire, additional, François, Bruno, additional, Boulain, Thierry, additional, Petitpas, Frank, additional, Constantin, Jean Michel, additional, Dhonneur, Gilles, additional, Baudin, François, additional, Combes, Alain, additional, Bohé, Julien, additional, Loriferne, Jean-François, additional, Cook, Fabrice, additional, Slama, Michel, additional, Leroy, Olivier, additional, Capellier, Gilles, additional, Dargent, Auguste, additional, Hissem, Tarik, additional, Bounab, Rania, additional, Maxime, Virginie, additional, Moine, Pierre, additional, Bellissant, Eric, additional, Annane, Djillali, additional, Djillali, ANNANE, additional, Christian, BRUN-BUISSON, additional, Benoit, MISSET, additional, Jean, CHASTRE, additional, François, BRIVET, additional, Julien, BOHE, additional, Carole, SCHWEBEL, additional, Shidasp, SIAMI, additional, Michel, SLAMA, additional, Olivier, LEROY, additional, Gilles, CAPELLIER, additional, Michel, WOLFF, additional, Mohamed, ALI BEN ALI, additional, François, ANTONINI, additional, Jean-François, LORIFERNE, additional, Franck, PETITPAS, additional, Claire, CHARPENTIER, additional, Jean-Michel, CONSTANTIN, additional, Gilles, D'HONNEUR, additional, Bertrand, SOUWEINE, additional, Xavier, FORCEVILLE, additional, Bruno, MEGARBANE, additional, Francois, BAUDIN, additional, Gwenhaël, COLIN, additional, Karim, ASEHNOUNE, additional, Jean-Pierre, QUENOT, additional, Bruno, FRANCOIS, additional, Thierry, BOULAIN, additional, Emmanuelle, MERCIER, additional, Jean, REIGNIER, additional, Roland, AMATHIEU, additional, Fabrice, COOK, additional, Alain, CARIOU, additional, Loic, CHIMOT, additional, Fouad, Fadel, additional, Andrea, Polito, additional, Bernard, Clair, additional, Virginie, Maxime, additional, David, Luis, additional, Tarek, Sharshar, additional, David, Orlikowski, additional, Keyvan, RAZAZI, additional, Nicolas, DE PROST, additional, Guillaume, CARTEAUX, additional, Maité, GARROUSTE ORGEAS, additional, François, Philippart, additional, Alain, Combes, additional, Ania, Nieszkowska, additional, Frederic, Jacobs, additional, Dominique, Prat, additional, Patrick, Lafforgue, additional, Claire, ARA SOMOHANO, additional, Clémence, MINET, additional, Maxime, LUGOSI, additional, Julien, Maizel, additional, Jean Christophe, Navellou, additional, Bruno, Mourvillier, additional, Lila, Bouadma, additional, Jean François, Timsit, additional, Claude Denis, Martin, additional, Julien, Textoris, additional, Sandrine, Wiramus, additional, Clément, BRUN, additional, Benoît, RAGONNET, additional, Ali, Ait-Hssain, additional, Samia, Touati, additional, Jean, Kuba, additional, Vincent, Willems, additional, Pierre, Lahillaire, additional, Mohammed, Lassi, additional, Marion, ANTONA, additional, Alia, MEGHENEM, additional, Marine, DEMESMAY, additional, Eric, Boulet, additional, Olivier, LOUTREL, additional, Romain, DUMONT, additional, Antoine, ROQUILLY, additional, Pierre-Joachim, MAHE, additional, Dominique, DEMEURE dit LATTE, additional, Philippe, CHAMPIN, additional, Jean François, ARNOULD, additional, Raphaël, CINOTTI, additional, Ronan, Le FLOCH, additional, Marc, Clavel, additional, Philippe, Vignon, additional, Nicolas, Pichon, additional, Emmanuelle, BEGOT, additional, Anne-Laure, FEDOU, additional, Catherine, CHAPELLAS, additional, Antoine, GALY, additional, Dalila, Benzekri Lefevre, additional, Armelle, Mathonnet, additional, Anne, Bretagnol, additional, Isabelle, Runge, additional, François, BARBIER, additional, Grégoire, MULLER, additional, Denis, GAROT, additional, Pierre François, DEQUIN, additional, Dominique, PERROTIN, additional, Annick, LEGRAS, additional, Julie, MANKIKIAN, additional, Patrice, TALEC, additional, Stephan, EHRMANN, additional, Aurélie, JORET, additional, Claire, LHOMMET, additional, Emmanuelle, ROUVE, additional, Laetitia, BODET-CONTENTIN, additional, Youenn, JOUAN, additional, Charlotte, SALMONGANDONNIERE, additional, Laurent, MARTIN-LEFEVRE, additional, Matthieu, HENRY-LAGARRIGUE, additional, Aihem, YEHIA, additional, Jean-Baptiste, LASCARROU, additional, Christine, LEBERT, additional, Jean-Claude, LACHERADE, additional, Eric, LEVESQUE, additional, Yen-Lan, NGUYEN, additional, Fabrice, DAVIAUD, additional, Adrien, BOUGLE, additional, Jean Paul, MIRA, additional, Jean Daniel, CHICHE, additional, Frederic, PENE, additional, Tristan, MORICHAU-BEAUCHANT, additional, Guillaume, GERI, additional, Pierre Henri, DESSALLES, additional, Yannick, MONSEAU, additional, Mélanie, SAINT-LEGER, additional, Sandrine, BEDON-CARTE, additional, Laetitia, Bodet-Contentin, additional, Walid, Darwiche, additional, Stephan, Ehrmann, additional, Denis, Garot, additional, Antoine, Guillon, additional, Youenn, Jouan, additional, Annick, Legras, additional, Julie, Mankikian, additional, Emmanuelle, Mercier, additional, Marlene, Morisseau, additional, Yonatan, Perez, additional, Emmanuelle, Rouve, additional, Charlotte, Salmon-Gandonniere, additional, Julie, Helms, additional, Hassene, Rahmani, additional, Alexandra, Monnier, additional, Hamid, Merdji, additional, Raphael, Clere-Jehl, additional, Laure, Stiel, additional, Antoine, Studer, additional, Pascal, Andreu, additional, Jean-Baptiste, Roudaut, additional, Marie, Labruyere, additional, Marine, Jacquier, additional, Francois, Barbier, additional, Dalila, Benzekri, additional, Thierry, Boulain, additional, Sophie, Jacquier, additional, Gregoire, Muller, additional, Mai-Anh, Nai, additional, Sophie, Tollec, additional, Damien, Roux, additional, Jonathan, Messika, additional, Constance, Vuillard, additional, Louis-Marie, Dumont, additional, Laura, Federici, additional, Noemie, Zucman, additional, Marc, Amouretti, additional, Djillali, Annane, additional, Pierre, Moine, additional, Paris, Meng, additional, Rania, Bounab, additional, Muriel-Sarah, Fartoukh, additional, Michel, Djibre, additional, Alexandre, Elabbadi, additional, Marie-Ange, Azais, additional, Konstantinos, Bachoumas, additional, Arthur, Bailly, additional, Remi, Bernardon, additional, Gauthier, Blonz, additional, Luc, Desmedt, additional, Brian, Emonet, additional, Maud, Fiancette, additional, Matthieu, Henry, additional, Jean-Claude, Lacherade, additional, Jean-Baptiste, Lascarrou, additional, Christine, Lebert, additional, Julien, Lorber, additional, Laurent Martin-, Lefevre, additional, Caroline, Pouplet, additional, Isabelle, Vinatier, additional, Aihem, Yehia, additional, Sarah, Benghanem, additional, Julien, Charpentier, additional, Clara, Vigneron, additional, Anne-Laure, Fedou, additional, Claire, Mancia, additional, Emmanuelle, Begot, additional, Thomas, Daix, additional, Antoine, Galy, additional, Celine, Gonzalez, additional, Marine, Goudelin, additional, Bruno, Evrard, additional, Arnaud, Desachy, additional, Julien, Vaidie, additional, Guillaume, Gilbert, additional, Cedric, Darreau, additional, Benoit, Derrien, additional, Marjorie, Saint-Martin, additional, Patrice, Tirot, additional, Mickael, Landais, additional, Nicolas, Chudeau, additional, Jean Christophe, Callahan, additional, Dominique, Vivier, additional, Charlene, Le Moal, additional, Pierre-Yves, Olivier, additional, Remy, Marnai, additional, Francis, Schneider, additional, Nicolas, Sedillot, additional, Xavier, Tchenio, additional, Adrien, Robine, additional, Yves, Poncelin, additional, and Remi, Bruyere, additional
Published: 2024
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22. Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France (the LIVE study): a multicentre, single-blind, randomised controlled trial

Author: Sophie, Cayot, Thomas, Godet, Renaud, Guerin, Camille, Verlac, Russel, Chabanne, Bernard, Cosserant, Raiko, Blondonnet, Alexandre, Lautrette, Nathanael, Eisenmann, Laurent, Muller, Pablo, Massanet, Caroline, Boutin, Saber, Barbar, Claire, Roger, Fouad, Belafia, Moussa, Cisse, Marion, Monnin, Matthieu, Conseil, Julie, Carr, Audrey, De Jong, Auguste, Dargent, Pascal, Andreu, Thomas, Lebouvrier, Yoann, Launey, Antoine, Roquilly, Raphael, Cinotti, Anne-Charlotte, Tellier, Mathilde, Barbaz, Benjamin, Cohen, Edouard, Lemarche, Pierre-Marie, Bertrand, Charlotte, Arberlot, Laurent, Zieleskiewicz, Emmanuelle, Hammad, Garry, Duclos, Calypso, Mathie, Herve, Dupont, Benoit, Veber, Jean-Christophe, Orban, Hervé, Quintard, Thomas, Rimmele, Julien, Crozon-Clauzel, Marinne, Le Core, Fabien, Grelon, Mona, Assefi, Frank, Petitas, Jerome, Morel, Serge, Molliex, Nanadougmar, Hadanou, Constantin, Jean-Michel, Jabaudon, Matthieu, Lefrant, Jean-Yves, Jaber, Samir, Quenot, Jean-Pierre, Langeron, Olivier, Ferrandière, Martine, Grelon, Fabien, Seguin, Philippe, Ichai, Carole, Veber, Benoit, Souweine, Bertrand, Uberti, Thomas, Lasocki, Sigismond, Legay, François, Leone, Marc, Eisenmann, Nathanael, Dahyot-Fizelier, Claire, Dupont, Hervé, Asehnoune, Karim, Sossou, Achille, Chanques, Gérald, Muller, Laurent, Bazin, Jean-Etienne, Monsel, Antoine, Borao, Lucile, Garcier, Jean-Marc, Rouby, Jean-Jacques, Pereira, Bruno, and Futier, Emmanuel
Published: 2019
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23. The Effect of an Accelerated Renal Replacement Therapy Initiation Is Not Modified by Baseline Risk

Author: Federico Angriman, Bruno L. Ferreyro, Natalia Angeloni, Bruno R. da Costa, Ron Wald, Sean M. Bagshaw, Neill K.J. Adhikari, Rinaldo Bellomo, Didier Dreyfuss, Bin Du, Martin P. Gallagher, Stéphane Gaudry, François Lamontagne, Michael Joannidis, Kathleen D. Liu, Daniel F. McAuley, Shay P. McGuinness, Alistair D. Nichol, Marlies Ostermann, Paul M. Palevsky, Haibo Qiu, Ville Pettilä, Antoine G. Schneider, Orla M. Smith, Suvi T. Vaara, Matthew Weir, Glenn M. Eastwood, Leah Peck, Helen Young, Peter Kruger, Gordon Laurie, Emma Saylor, Jason Meyer, Ellen Venz, Krista Wetzig, Craig French, Forbes McGain, John Mulder, Gerard Fennessy, Sathyajith Koottayi, Samantha Bates, Miriam Towns, Rebecca Morgan, Anna Tippett, Andrew Udy, Chris Mason, Elisa Licari, Dashiell Gantner, Jason McClure, Alistair Nichol, Phoebe McCracken, Jasmin Board, Emma Martin, Shirley Vallance, Meredith Young, Chelsey Vladic, Steve McGloughlin, David Gattas, Heidi Buhr, Jennifer Coles, Debra Hutch, James Wun, Louise Cole, Christina Whitehead, Julie Lowrey, Kristy Masters, Rebecca Gresham, Victoria Campbell, David Gutierrez, Jane Brailsford, Loretta Forbes, Lauren Murray, Teena Maguire, Martina NiChonghaile, Neil Orford, Allison Bone, Tania Elderkin, Tania Salerno, Tim Chimunda, Jason Fletcher, Emma Broadfield, Sanjay Porwal, Cameron Knott, Catherine Boschert, Julie Smith, Angus Richardson, Dianne Hill, Graeme Duke, Peter Oziemski, Santiago Cegarra, Peter Chan, Deborah Welsh, Stephanie Hunter, Owen Roodenburg, John Dyett, Nicos Kokotsis, Max Moser, Yang Yang, Laven Padayachee, Joseph Vetro, Himangsu Gangopadhyay, Melissa Kaufman, Angaj Ghosh, Simone Said, Alpesh Patel, Shailesh Bihari, Elisha Matheson, Xia Jin, Tapaswi Shrestha, Kate Schwartz, Rosalba Cross, Winston Cheung, Helen Wong, Mark Kol, Asim Shah, Amanda Y. Wang, Zoltan Endre, Celia Bradford, Pierre Janin, Simon Finfer, Naomi Diel, Jonathan Gatward, Naomi Hammond, Anthony Delaney, Frances Bass, Elizabeth Yarad, Hergen Buscher, Claire Reynolds, Nerilee Baker, Romuald Bellmann, Andreas Peer, Julia Hasslacher, Paul Koglberger, Sebastian Klein, Klemens Zotter, Anna Brandtner, Armin Finkenstedt, Adelheid Ditlbacher, Frank Hartig, Dietmar Fries, Mirjam Bachler, Bettina Schenk, Martin Wagner, Philipp Eller, Thomas Staudinger, Esther Tiller, Peter Schellongowski, Andja Bojic, Eric A. Hoste, Stephanie Bracke, Luc De Crop, Daisy Vermeiren, Fernando Thome, Bianca Chiella, Lucia Fendt, Veronica Antunes, Frédérick D'Aragon, Charles St-Arnaud, Michael Mayette, Élaine Carbonnaeu, Joannie Marchand, Marie-Hélène Masse, Marilène Ladouceur, Alexis F. Turgeon, François Lauzier, David Bellemare, Charles Langis Francoeur, Guillaume LeBlanc, Gabrielle Guilbault, Stéphanie Grenier, Eve Cloutier, Annick Boivin, Charles Delisle-Thibault, Panagiota Giannakouros, Olivier Costerousse, Jean-François Cailhier, François-Martin Carrier, Ali Ghamraoui, Martine Lebrasseur, Fatna Benettaib, Maya Salamé, Dounia Boumahni, Ying Tung Sia, Jean-François Naud, Isabelle Roy, Henry T. Stelfox, Stacey Ruddell, Braden J. Manns, Shelley Duggan, Dominic Carney, Jennifer Barchard, Richard P. Whitlock, Emilie Belley-Cote, Nevena Savija, Alexandra Sabev, Troy Campbell, Thais Creary, Kelson Devereaux, Shira Brodutch, Claudio Rigatto, Bojan Paunovic, Owen Mooney, Anna Glybina, Oksana Harasemiw, Michelle Di Nella, John Harmon, Navdeep Mehta, Louis Lakatos, Nicole Haslam, Francois Lellouche, Mathieu Simon, Ying Tung, Patricia Lizotte, Pierre-Alexandre Bourchard, Bram Rochwerg, Tim Karachi, Tina Millen, John Muscedere, David Maslove, J. Gordon Boyd, Stephanie Sibley, John Drover, Miranda Hunt, Ilinca Georgescu, Randy Wax, Ilan Lenga, Kavita Sridhar, Andrew Steele, Kelly Fusco, Taneera Ghate, Michael Tolibas, Holly Robinson, Matthew A. Weir, Ravi Taneja, Ian M. Ball, Amit Garg, Eileen Campbell, Athena Ovsenek, Sean van Diepen, Nadia Baig, Sheldon Magder, Han Yao, Ahsan Alam, Josie Campisi, Erika MacIntyre, Ella Rokosh, Kimberly Scherr, Stephen Lapinsky, Sangeeta Mehta, Sumesh Shah, Daniel J. Niven, Michael Russell, Kym Jim, Gillian Brown, Kerry Oxtoby, Adam Hall, Luc Benoit, Colleen Sokolowski, Bhanu Prasad, Jag Rao, Shelley Giebel, Demetrios J. Kutsogiannis, Patricia Thompson, Tayne Thompson, Robert Cirone, Kanthi Kavikondala, Mark Soth, France Clarke, Alyson Takaoka, David Mazer, Karen Burns, Jan Friedrich, David Klein, Gyan Sandhu, Marlene Santos, Imrana Khalid, Jennifer Hodder, Peter Dodek, Najib Ayas, Victoria Alcuaz, Gabriel Suen, Oleksa Rewa, Gurmeet Singh, Sean Norris, Neil Gibson, Castro Arias, Aysha Shami, Celine Pelletier, Alireza Zahirieh, Andre Amaral, Nicole Marinoff, Navjot Kaur, Adic Perez, Jane Wang, Gregory Haljan, Christopher Condin, Lauralyn McIntyre, Brigette Gomes, Rebecca Porteous, Irene Watpool, Swapnil Hiremath, Edward Clark, Margaret S. Herridge, Felicity Backhouse, M. Elizabeth Wilcox, Karolina Walczak, Vincent Ki, Asheer Sharman, Martin Romano, R.T. Noel Gibney, Adam S. Romanovsky, Lorena McCoshen, Gordon Wood, Daniel Ovakim, Fiona Auld, Gayle Carney, Meili Duan, Xiaojun Ji, Dongchen Guo, Zhili Qi, Jin Lin, Meng Zhang, Lei Dong, Jingfeng Liu, Pei Liu, Deyuan Zhi, Guoqiang Bai, Yu Qiu, Ziqi Yang, Jing Bai, Zhuang Liu, Haizhou Zhuang, Haiman Wang, Jian Li, Mengya Zhao, Xiao Zhou, Xianqing Shi, Baning Ye, Manli Liu, Jing Wu, Yongjian Fu, Dali Long, Yu Pan, Jinlong Wang, Huaxian Mei, Songsong Zhang, Mingxiang Wen, Enyu Yang, Sijie Mu, Jianquan Li, Tingting Hu, Bingyu Qin, Min Li, Cunzhen Wang, Xin Dong, Kaiwu Wang, Haibo Wang, Jianxu Yang, Chuanyao Wang, Dongxin Wang, Nan Li, Zhui Yu, Song Xu, Lan Yao, Guo Hou, Zhou Liu, Liping Lu, Yingtao Lian, Chunting Wang, Jichen Zhang, Ruiqi Ding, Guoqing Qi, Qizhi Wang, Peng Wang, Zhaoli Meng, Man Chen, Xiaobo Hu, Xiandi He, Shibing Zhao, Lele Hang, Rui Li, Suhui Qin, Kun Lu, Shijuan Dun, Cheng Liu, Qi Zhou, Zhenzhen Chen, Jing Mei, Minwei Zhang, Hao Xu, Jincan Lin, Qindong Shi, Lijuan Fu, Qinjing Zeng, Hongye Ma, Jinqi Yan, Lan Gao, Hongjuan Liu, Lei Zhang, Hao Li, Xiaona He, Jingqun Fan, Litao Guo, Yu Liu, Xue Wang, Jingjing Sun, Zhongmin Liu, Juan Yang, Lili Ding, Lulu Sheng, Xingang Liu, Jie Yan, Quihui Wang, Yifeng Wang, Dan Zhao, Shuangping Zhao, Chenghuan Hu, Jing Li, Fuxing Deng, Haibo Qui, Yi Yang, Min Mo, Chun Pan, Changde Wu, Yingzi Huang, Lili Huang, Airan Liu, Anna-Maija Korhonen, Sanna Törnblom, Sari Sutinen, Leena Pettilä, Jonna Heinonen, Eliria Lappi, Taria Suhonen, Sari Karlsson, Sanna Hoppu, Ville Jalkanen, Anne Kuitunen, Markus Levoranta, Jaakko Långsjö, Sanna Ristimäki, Kaisa Malila, Anna Wootten, Simo Varila, Mikko J Järvisalo, Outi Inkinen, Satu Kentala, Keijo Leivo, Paivi Haltia, Jean-Damien Ricard, Jonathan Messika, Abirami Tiagarajah, Malo Emery, Aline Dechanet, Coralie Gernez, Damien Roux, Laurent Martin-Lefevre, Maud Fiancette, Isabelle Vinatier, Jean Claude Lacherade, Gwenhaël Colin, Christine Lebert, Marie-Ange Azais, Aihem Yehia, Caroline Pouplet, Matthieu Henry- Lagarrigue, Amélie Seguin, Laura Crosby, Julien Maizel, Dimitri Titeca-Beauport, Alain Combes, Ania Nieszkowska, Paul Masi, Alexandre Demoule, Julien Mayaux, Martin Dres, Elise Morawiec, Maxens Decalvele, Suela Demiri, Morgane Faure, Clémence Marios, Maxime Mallet, Marie Amélie Ordon, Laura Morizot, Marie Cantien, François Pousset, Florent Poirson, Yves Cohen, Laurent Argaud, Martin Cour, Laurent Bitker, Marie Simon, Romain Hernu, Thomas Baudry, Sylvie De La Salle, Adrien Robine, Nicholas Sedillot, Xavier Tchenio, Camille Bouisse, Sylvie Roux, Fabienne Tamion, Steven Grangé, Dorothée Carpentier, Guillaume Chevrel, Luis Ensenyat-Martin, Sophie Marque, Jean-Pierre Quenot, Pascal Andreu, Auguste Dargent, Audrey Large, Nicolas Chudeau, Mickael Landais, Benoit Derrien, Jean Christophe Callahan, Christophe Guitton, Charlène Le Moal, Alain Robert, Karim Asehnoune, Raphaël Cinotti, Nicolas Grillot, Dominique Demeure, Christophe Vinsonneau, Imen Rahmani, Mehdi Marzouk, Thibault Dekeyser, Caroline Sejourne, Mélanie Verlay, Fabienne Thevenin, Lucie Delecolle, Didier Thevenin, Bertrand Souweine, Elisabeth Coupez, Mireille Adda, Jean-Pierre Eraldi, Antoine Marchalot, Nicolas De Prost, Armand Mekontso Dessap, Keyvan Razazi, Ferhat Meziani, Julie Boisrame-Helms, Raphael Clere-Jehl, Xavier Delabranche, Christine Kummerlen, Hamid Merdji, Alexandra Monnier, Yannick Rabouel, Hassene Rahmani, Hayat Allam, Samir Chenaf, Vincenta Franja, Bertrand Pons, Michel Carles, Frédéric Martino, Régine Richard, Benjamin Zuber, Guillaume Lacave, Karim Lakhal, Bertrand Rozec, Hoa Dang Van, Éric Boulet, Fouad Fadel, Cedric Cleophax, Nicolas Dufour, Caroline Grant, Marie Thuong, Jean Reignier, Emmanuel Canet, Laurent Nicolet, Thierry Boulain, Mai-Anh Nay, Dalila Benzekri, François Barbier, Anne Bretagnol, Toufik Kamel, Armelle Mathonnet, Grégoire Muller, Marie Skarzynski, Julie Rossi, Amandine Pradet, Sandra Dos Santos, Aurore Guery, Lucie Muller, Luis Felix, Julien Bohé, Guillaume Thiéry, Nadia Aissaoui, Damien Vimpere, Morgane Commeureuc, Jean-Luc Diehl, Emmanuel Guerot, Orfeas Liangos, Monika Wittig, Alexander Zarbock, Mira Küllmar, Thomas van Waegeningh, Nadine Rosenow, Kathy Brickell, Peter Doran, Patrick T. Murray, Giovanni Landoni, Rosalba Lembo, Alberto Zangrillo, Giacomo Monti, Margherita Tozzi, Matteo Marzaroli, Gaetano Lombardi, Gianluca Paternoster, Michelangelo Vitiello, Shay McGuinness, Rachael Parke, Magdalena Butler, Eileen Gilder, Keri-Anne Cowdrey, Samantha Wallace, Jane Hallion, Melissa Woolett, Philippa Neal, Karina Duffy, Stephanie Long, Colin McArthur, Catherine Simmonds, Yan Chen, Rachael McConnochie, Lynette Newby, David Knight, Seton Henderson, Jan Mehrtens, Stacey Morgan, Anna Morris, Kymbalee Vander Hayden, Tara Burke, Matthew Bailey, Ross Freebairn, Lesley Chadwick, Penelope Park, Christine Rolls, Liz Thomas, Ulrike Buehner, Erin Williams, Jonathan Albrett, Simon Kirkham, Carolyn Jackson, Troy Browne, Jennifer Goodson, David Jackson, James Houghton, Owen Callender, Vicki Higson, Owen Keet, Clive Dominy, Paul Young, Anna Hunt, Harriet Judd, Cassie Lawrence, Shaanti Olatunji, Yvonne Robertson, Charlotte Latimer-Bell, Deborah Hendry, Agnes Mckay-Vucago, Nina Beehre, Eden Lesona, Leanlove Navarra, Chelsea Robinson, Ryan Jang, Andrea Junge, Bridget Lambert, Michel Thibault, Philippe Eckert, Sébastien Kissling, Erietta Polychronopoulos, Elettra Poli, Marco Altarelli, Madeleine Schnorf, Samia Abed Mallaird, Claudia Heidegger, Aurelie Perret, Philippe Montillier, Frederic Sangla, Seigenthaller Neils, Aude De Watteville, Mandeep-Kaur Phull, Aparna George, Nauman Hussain, Tatiana Pogreban, Steve Lobaz, Alison Daniels, Mishell Cunningham, Deborah Kerr, Alice Nicholson, Pradeep Shanmugasundaram, Judith Abrams, Katarina Manso, Geraldine Hambrook, Elizabeth McKerrow, Juvy Salva, Stephen Foulkes, Matthew Wise, Matt Morgan, Jenny Brooks, Jade Cole, Tracy Michelle Davies, Helen Hill, Emma Thomas, Marcela Vizcaychipi, Behrad Baharlo, Jaime Carungcong, Patricia Costa, Laura Martins, Ritoo Kapoor, Tracy Hazelton, Angela Moon, Janine Musselwhite, Ben Shelley, Philip McCall, Gill Arbane, Aneta Bociek, Martina Marotti, Rosario Lim, Sara Campos, Neus Grau Novellas, Armando Cennamo, Andrew Slack, Duncan Wyncoll, Luigi Camporota, Simon Sparkes, Rosalinde Tilley, Austin Rattray, Gayle Moreland, Jane Duffy, Elizabeth McGonigal, Philip Hopkins, Clare Finney, John Smith, Harriet Noble, Hayley Watson, Claire-Louise Harris, Emma Clarey, Eleanor Corcoran, James Beck, Clare Howcroft, Nora Youngs, Elizabeth Wilby, Bethan Ogg, Adam Wolverson, Sandra Lee, Susie Butler, Maryanne Okubanjo, Julia Hindle, Ingeborg Welters, Karen Williams, Emily Johnson, Julie Patrick-Heselton, David Shaw, Victoria Waugh, Richard Stewart, Esther Mwaura, Lynn Wren, Louise Mew, Sara-Beth Sutherland, Jane Adderley, Jim Ruddy, Margaret Harkins, Callum Kaye, Teresa Scott, Wendy Mitchell, Felicity Anderson, Fiona Willox, Vijay Jagannathan, Michele Clark, Sarah Purv, Andrew Sharman, Megan Meredith, Lucy Ryan, Louise Conner, Cecilia Peters, Dan Harvey, Ashraf Roshdy, Amy Collins, Malcolm Sim, Steven Henderson, Nigel Chee, Sally Pitts, Katie Bowman, Maria Dilawershah, Luke Vamplew, Elizabeth Howe, Paula Rogers, Clara Hernandez, Clara Prendergast, Jane Benton, Alex Rosenberg, Lui G. Forni, Alice Grant, Paula Carvelli, Ajay Raithatha, Sarah Bird, Max Richardson, Matthew Needham, Claire Hirst, Jonathan Ball, Susannah Leaver, Luisa Howlett, Carlos Castro Delgado, Sarah Farnell-Ward, Helen Farrah, Geraldine Gray, Gipsy Joseph, Francesca Robinson, Ascanio Tridente, Clare Harrop, Karen Shuker, Derek McLaughlan, Judith Ramsey, Sharon Meehan, Bernd Oliver Rose, Rosie Reece-Anthony, Babita Gurung, Tony Whitehouse, Catherine Snelson, Tonny Veenith, Andy Johnston, Lauren Cooper, Ron Carrera, Karen Ellis, Emma Fellows, Samanth Harkett, Colin Bergin, Elaine Spruce, Liesl Despy, Stephanie Goundry, Natalie Dooley, Tracy Mason, Amy Clark, Gemma Dignam, Geraldine Ward, Ben Attwood, Penny Parsons, Sophie Mason, Michael Margarson, Jenny Lord, Philip McGlone, Luke E. Hodgson, Indra Chadbourn, Raquel Gomez, Jordi Margalef, Rinus Pretorius, Alexandra Hamshere, Joseph Carter, Hazel Cahill, Lia Grainger, Kate Howard, Greg Forshaw, Zoe Guy, Kianoush B. Kashani, Robert C. Albright, Amy Amsbaugh, Anita Stoltenberg, Alexander S. Niven, Matthew Lynch, AnnMarie O'Mara, Syed Naeem, Sairah Sharif, Joyce McKenney Goulart, Ashita Tolwani, Claretha Lyas, Laura Latta, Azra Bihorac, Haleh Hashemighouchani, Philip Efron, Matthew Ruppert, Julie Cupka, Sean Kiley, Joshua Carson, Peggy White, George Omalay, Sherry Brown, Laura Velez, Alina Marceron, Javier A. Neyra, Juan Carlos Aycinena, Madona Elias, Victor M. Ortiz-Soriano, Caroline Hauschild, and Robert Dorfman
Subjects: Renal Replacement Therapy, Pulmonary and Respiratory Medicine, Critical Illness, Medicine and Health Sciences, Humans, Acute Kidney Injury
Published: 2022
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24. Extubation in neurocritical care patients: lesson learned

Author: Raphaël Cinotti, Giuseppe Citerio, Karim Asehnoune, Cinotti, R, Citerio, G, and Asehnoune, K
Subjects: neurocritical care, Extubation, Critical Care and Intensive Care Medicine
Published: 2022
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25. Anxiety and depression symptoms in relatives of moderate-to-severe traumatic brain injury survivors — A multicentre cohort

Author: Raphaël Cinotti, Alice Chopin, Jean Denis Moyer, Olivier Huet, Sigismond Lasocki, Benjamin Cohen, Claire Dahyot-Fizelier, Kevin Chalard, Philippe Seguin, Florian Pierre Martin, Céline Lerebourg, Marie Guitteny, Amandine Chenet, Brigitte Perrouin-Verbe, Karim Asehnoune, Fanny Feuillet, Véronique Sébille, and Antoine Roquilly
Subjects: Anesthesiology and Pain Medicine, General Medicine, Critical Care and Intensive Care Medicine
Published: 2023
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26. Does Differential Item Functioning Jeopardize the Comparability of Health-Related Quality of Life Assessment Between Patients and Proxies in Patients with Moderate-to-Severe Traumatic Brain Injury?

Author: Véronique Sébille, Yseulys Dubuy, Fanny Feuillet, Myriam Blanchin, Antoine Roquilly, and Raphaël Cinotti
Subjects: Neurology (clinical), Critical Care and Intensive Care Medicine
Published: 2023
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27. 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
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28. Les missions et objectifs du Réseau recherche de la Société française d’anesthésie et de réanimation

Author: Sébastien Kerever, Morgan Le Guen, Hélène Beloeil, Matthieu Biais, Chafia Daoui, Amélie Yavchitz, Ludovic Meuret, Raphaël Cinotti, Stéphanie Sigaut, Jean-Noël Evain, and Aurélien Mazereaud
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, 030220 oncology & carcinogenesis, 3. Good health
Abstract: Resume Depuis une dizaine d’annees, la recherche clinique en Anesthesie-Reanimation voit une augmentation du nombre de protocoles developpes et de publications, tant au niveau medical que paramedical. Des reseaux tres structures existent a l’etranger et imposent une concurrence importante dans la course a l’innovation, ainsi qu’au deroulement et a la valorisation des protocoles de recherche. La complexification recente de la methodologie de la recherche clinique rend la professionnalisation et la structuration de la recherche clinique au sein de notre societe savante necessaires. Le Comite Reseau Recherche de la Societe francaise d’anesthesie et de reanimation (SFAR) a pour but de fournir un label qualite a la recherche clinique medicale et paramedicale, grâce a un accompagnement des projets de recherche tout au long du processus : expertise et interaction avec les investigateurs, recrutement des centres, suivi du deroulement des etudes, aide a la redaction des articles. Les objectifs sont d’aider les investigateurs a optimiser les chances de financements de projets, d’assurer la faisabilite des travaux et de valoriser scientifiquement les resultats. Pour la SFAR, cette valorisation des travaux de recherche nationaux participe au rayonnement international de notre specialite.
Published: 2021
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29. Risk factors for therapeutic failure in the management of post-operative peritonitis: a post hoc analysis of the DURAPOP trial

Author: Karim Asehnoune, Sebastien Pease, Philippine Eloy, Alexandre Mignon, Marina Esposito-Farèse, Pascal Raclot, Sami Jaber, Joel Cousson, Soizic Gergaud, Hervé Dupont, Marc Beaussier, Josette Gally, Claude Girard, Melanie Levrard, Claude Meistelman, Gilles Blasco, Jean-Francois Payen, Philippe Gouin, Nathalie Grall, Olivier Collanges, Paer Abback, Thomas Lescot, Sigismond Lasocki, Thomas Gaillard, Sebastien Pily-Floury, Antoine Tesniere, Gaëtan Plantefève, Jean-François Georger, Benoit Veber, Philippe Montravers, Christian Auboyer, Marie-Christine Herault, Florent Wallet, Jean-François Perrier, Regis Bronchard, Yazine Mahjoub, Alain Lepape, Vincent Piriou, Thierry Floch, Emmanuel Samain, Emmanuel Weiss, Thomas Clavier, Mathieu Desmard, Philippe Seguin, Candice Tassin, Yoann Launey, Nouria Belhadj-Tahar, Raphaël Cinotti, Olivier Pajot, Guillaume Besch, Catherine Paugam, Boris Jung, Jean-Marc Delay, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Physiopathologie et Epidémiologie des Maladies Respiratoires (PHERE (UMR_S_1152 / U1152)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Centre d'investigation Clinique [CHU Bichat] - Épidémiologie clinique (CIC 1425), 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), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, CHU Rouen, Normandie Université (NU), CHU Pontchaillou [Rennes], Hôpital Beaujon [AP-HP], Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP), CHU Amiens-Picardie, Université de Picardie Jules Verne (UPJV), DURAPOP trial group: Philippe Montravers, Regis Bronchard, Mathieu Desmard, Herve Dupont, Melanie Levrard, Yazine Mahjoub, Sigismond Lasocki, Soizic Gergaud, Thomas Gaillard, Gaetan Plantefeve, Olivier Pajot, Gilles Blasco, Emmanuel Samain, Guillaume Besch, Sebastien Pily-Floury, Catherine Paugam, Sebastien Pease, Paer Abback, Claude Girard, Jean-Francois Payen, Marie-Christine Herault, Sami Jaber, Boris Jung, Jean-Marc Delay, Josette Gally, Claude Meistelman, Jean-François Perrier, Karim Asehnoune, Raphael Cinotti, Antoine Tesniere, Alexandre Mignon, Thomas Lescot, Nouria Belhadj-Tahar, Marc Beaussier, Alain Lepape, Vincent Piriou, Florent Wallet, Candice Tassin, Joel Cousson, Pascal Raclot, Thierry Floch, Philippe Seguin, Yoann Launey, Benoit Veber, Philippe Gouin, Thomas Clavier, Christian Auboyer, Olivier Collanges, Jean-François Georger, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Simplification des soins chez les patients complexes - UR UPJV 7518 (SSPC), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), and MORNET, Dominique
Subjects: medicine.medical_treatment, [SDV]Life Sciences [q-bio], Penicillanic Acid, Logistic regression, 0302 clinical medicine, MESH: Risk Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Risk Factors, Pharmacology (medical), 030212 general & internal medicine, MESH: Penicillanic Acid, Prospective Studies, Original Research, 3. Good health, Anti-Bacterial Agents, Infectious Diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, AcademicSubjects/MED00290, Piperacillin, Tazobactam Drug Combination, [SDV.SP.PHARMA] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Piperacillin/tazobactam, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, medicine.drug, Microbiology (medical), MESH: Piperacillin, medicine.medical_specialty, MESH: Peritonitis, Peritonitis, Tazobactam, 03 medical and health sciences, Internal medicine, MESH: Anti-Bacterial Agents, Post-hoc analysis, medicine, AcademicSubjects/MED00740, Humans, Renal replacement therapy, [SDV.MP] Life Sciences [q-bio]/Microbiology and Parasitology, Pharmacology, Piperacillin, MESH: Humans, business.industry, 030208 emergency & critical care medicine, medicine.disease, Comorbidity, MESH: Prospective Studies, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, business, AcademicSubjects/MED00230
Abstract: Background Therapeutic failure is a frequent issue in the management of post-operative peritonitis. Objectives A post hoc analysis of the prospective, multicentre DURAPOP trial analysed the risk factors for failures in post-operative peritonitis following adequate source control and empirical antibiotic therapy in critically ill patients. Patients and methods Overall failures assessed post-operatively between Day 8 and Day 45 were defined as a composite of death and/or surgical and/or microbiological failures. Risk factors for failures were assessed using logistic regression analyses. Results Among the 236 analysed patients, overall failures were reported in 141 (59.7%) patients, including 30 (12.7%) deaths, 81 (34.3%) surgical and 95 (40.2%) microbiological failures. In the multivariate analysis, the risk factors associated with overall failures were documented piperacillin/tazobactam therapy [adjusted OR (aOR) 2.10; 95% CI 1.17–3.75] and renal replacement therapy on the day of reoperation (aOR 2.96; 95% CI 1.05–8.34). The risk factors for death were age (aOR 1.08 per year; 95% CI 1.03–1.12), renal replacement therapy on reoperation (aOR 3.95; 95% CI 1.36–11.49) and diabetes (OR 6.95; 95% CI 1.34–36.03). The risk factors associated with surgical failure were documented piperacillin/tazobactam therapy (aOR 1.99; 95% CI 1.13–3.51), peritoneal cultures containing Klebsiella spp. (aOR 2.45; 95% CI 1.02–5.88) and pancreatic source of infection (aOR 2.91; 95% CI 1.21–7.01). No specific risk factors were identified for microbiological failure. Conclusions Our data suggest a predominant role of comorbidities, the severity of post-operative peritonitis and possibly of documented piperacillin/tazobactam treatment on the occurrence of therapeutic failures, regardless of their type.
Published: 2021
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30. An update on remimazolam and anaphylaxis

Author: Raphaël Cinotti
Subjects: Anesthesiology and Pain Medicine
Published: 2023
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31. Relationship between health-related quality-of-life and functional outcome 6 months after moderate to severe TBI

Author: Raphaël Cinotti, Antoine Roquilly, Alice Chopin, Florian Pierre Martin, Yoanna Morato, Céline Lerebourg, Jean Denis Moyer, Olivier Huet, Sigismond Lasocki, Benjamin Cohen, Claire Dahyot-Fizelier, Kevin Chalard, Philippe Seguin, Amandine Chenet, Brigitte Perrouin-Verbe, Debajyoti Sinha, Karim Asehnoune, Fanny Feuillet, and Véronique Sébille
Subjects: Rehabilitation, Orthopedics and Sports Medicine
Published: 2023
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32. Assessment of remifentanil for rapid sequence induction and intubation in patients at risk of pulmonary aspiration of gastric contents compared to rapid-onset paralytic agents: study protocol for a non-inferiority simple blind randomized controlled trial (the REMICRUSH study)

Author: Olivier Huet, Alexandra Jobert, Vincent Minville, Jean-Stéphane David, Delphine Flattres-Duchaussoy, Pierre Bouzat, Olivier Langeron, Fanny Feuillet, Marc Danguy des Déserts, Antoine Roquilly, Charlene Le Moal, Celine Lerebourg, Sigismond Lasocki, Nicolas Grillot, Elodie Faurel-Paul, Younes El Amine, Martine Tching-Sin, Nolwenn Chatel-Josse, Raphaël Cinotti, Mathieu Oudot, Karim Asehnoune, Matthias Garot, Nathalie Bruneau, Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Lille, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Neuro-imagerie fonctionnelle et métabolique (ANTE-INSERM U836, équipe 5), Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Valenciennes, Department of Anesthesiology and Critical Care, Hospital Inter-Armée Clermont Tonnerre, Brest, MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), and Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques
Subjects: Adult, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Remifentanil, Medicine (miscellaneous), Succinylcholine, law.invention, 03 medical and health sciences, Study Protocol, 0302 clinical medicine, Randomized controlled trial, 030202 anesthesiology, law, medicine, Intubation, Intratracheal, Intubation, Humans, Multicenter Studies as Topic, Pharmacology (medical), 030212 general & internal medicine, Rocuronium, Rapid Sequence Induction and Intubation, Randomized Controlled Trials as Topic, Full stomach patient, Paralytic agents, lcsh:R5-920, business.industry, Tracheal intubation, Rapid sequence induction, medicine.disease, 3. Good health, Muscle relaxation, Pulmonary aspiration, Anesthesia, business, lcsh:Medicine (General), medicine.drug
Abstract: Background Rapid-onset paralytic agents are recommended to achieve muscle relaxation and facilitate tracheal intubation during rapid sequence induction in patients at risk of pulmonary aspiration of gastric contents. However, opioids are frequently used in this setting. The study’s objective is to demonstrate the non-inferiority of remifentanil compared to rapid-onset paralytic agents, in association with an hypnotic drug, for tracheal intubation in patients undergoing procedure under general anesthesia and at risk of pulmonary aspiration of gastric contents. Methods The REMICRUSH (Remifentanil for Rapid Sequence Induction of Anaesthesia) study is a multicenter, single-blinded, non-inferiority randomized controlled trial comparing remifentanil (3 to 4 μg/kg) with rapid-onset paralytic agents (succinylcholine or rocuronium 1 mg/kg) for rapid sequence induction in 1150 adult surgical patients requiring tracheal intubation during general anesthesia. Enrolment started in October 2019 in 15 French anesthesia units. The expected date of the final follow-up is October 2021. The primary outcome is the proportion of successful tracheal intubation without major complications. A non-inferiority margin of 7% was chosen. Analyses of the intent-to-treat and per-protocol populations are planned. Discussion The REMICRUSH trial protocol has been approved by the ethics committee of The Comité de Protection des Personnes Sud-Ouest et Outre-Mer II and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentations at scientific conferences and publications in peer-reviewed journals. The REMICRUSH trial is the first randomized controlled trial powered to investigate whether remifentanil with hypnotics is non-inferior to rapid-onset paralytic agents with hypnotic in rapid sequence induction of anesthesia for full stomach patients considering successful tracheal intubation without major complication. Trial registration ClinicalTrials.gov NCT03960801. Registered on May 23, 2019.
Published: 2021
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33. Building a better machine learning model of extubation for neurocritical care patients. Author’s reply

Author: Romain Pirracchio, Karim Asehnoune, and Raphaël Cinotti
Subjects: Critical Care and Intensive Care Medicine
Published: 2022
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34. Continuous Pneumatic Regulation of Tracheal Cuff Pressure to Decrease Ventilator-associated Pneumonia in Trauma Patients Who Were Mechanically Ventilated

Author: Olivier Mimoz, Benoit Veber, Matthieu Boisson, Dominique Falcon, Carole Ichai, Claire-Marie Drevet, Lilit Kelesyan, Thiên-Nga Chamaraux-Tran, Laurent Muler, Julien Pottecher, Marc Leone, Abdelouaid Nadji, Hervé Quintard, Claire Dahyot-Fizelier, Belaid Bouhemad, Nicolas Marjanovic, Sigismond Lasocki, Claire Roger, Thomas Kerforne, Jean-Yves Lefrant, Catherine Paugam-Burtz, Marc Ginet, Antoine Roquilly, Elodie Caumon, Emmanuelle Hammad, Florian Grimaldi, Pierre-Olivier Ludes, Jérémy Guenezan, Arnaud Foucrier, Sébastien Leduc, Guillaume Besch, Sabrina Seguin, Russell Chabanne, Karim Asehnoune, Philippe Gouin, Pierre-Gildas Guitard, Denis Frasca, Maxime Léger, Sebastien Pili-Floury, Raphaël Cinotti, Marie-Héléne Po, Joe de Keizer, Soizic Gergaud, Thomas Gaillard, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Nantes (CHU Nantes), Département d'Anesthésie et Réanimation [Hôpital Beaujon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Département d'Anesthésie-Réanimation [CHU Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Centre Hospitalier Universitaire de Nice (CHU Nice), Aix Marseille Université (AMU), Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Hôpital de Hautepierre [Strasbourg], Université de Strasbourg - Faculté de Médecine [Strabourg] (FMTS), Initial MAnagement and prevention of acute orGan failures IN critically ill patiEnts (IMAGINE), Université de Montpellier (UM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Hospitalier Universitaire [Grenoble] (CHU), Service de soins intensifs [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), CHU Clermont-Ferrand, Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), AGATE Study Group: Guillaume Besch, Bélaid Bouhemad, Elodie Caumon, Thien-Nga Chamaraux-Tran, Raphael Cinotti, Thomas Gaillard, Soizic Gergaud, Marc Ginet, Philippe Gouin, Florian Grimaldi, Pierre-Gildas Guitard, Emmanuelle Hammad, Lilit Kelesyan, Sébastien Leduc, Maxime Leger, Pierre-Olivier Ludes, Laurent Muler, Abdelouaid Nadji, Catherine Paugam-Burtz, Marie-Héléne Po, Hervé Quintard, Claire Roger, Antoine Roquilly, Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO), Chauzy, Alexia, Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), and Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Population, Critical Care and Intensive Care Medicine, Tracheal tube, 03 medical and health sciences, 0302 clinical medicine, Intensive care, ventilator-associated, medicine, pneumonia, 030212 general & internal medicine, education, intensive care, Mechanical ventilation, education.field_of_study, business.industry, Tracheal intubation, Ventilator-associated pneumonia, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, medicine.disease, infection, 3. Good health, [SDV] Life Sciences [q-bio], [SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences, 030228 respiratory system, Anesthesia, Cuff, tracheal cuff pressure, Injury Severity Score, Cardiology and Cardiovascular Medicine, business
Abstract: International audience; Background: Ventilator-associated pneumonia (VAP) is the most frequent health care-associated infection in severely ill patients, and aspiration of contaminated oropharyngeal content around the cuff of the tracheal tube is the main route of contamination.Research question: Is continuous regulation of tracheal cuff pressure using a pneumatic device superior to manual assessment three times daily using a portable manometer (routine care) in preventing VAP in patients with severe trauma?Study design and methods: In this open-label, randomized controlled superiority trial conducted in 13 French ICUs, adults (age ≥ 18 years) with severe trauma (Injury Severity Score > 15) and requiring invasive mechanical ventilation for ≥ 48 h were enrolled. Patients were randomly assigned (1:1) via a secure Web-based random number generator in permuted blocks of variable sizes to one of two groups according to the method of tracheal cuff pressure control. The primary outcome was the proportion of patients developing VAP within 28 days following the tracheal intubation, as determined by two assessors masked to group assignment, in the modified intention-to-treat population. This study is closed to new participants.Results: A total of 434 patients were recruited between July 31, 2015, and February 15, 2018, of whom 216 were assigned to the intervention group and 218 to the control group. Seventy-three patients (33.8%) developed at least one episode of VAP within 28 days following the tracheal intubation in the intervention group compared with 64 patients (29.4%) in the control group (adjusted subdistribution hazard ratio, 0.96; 95% CI, 0.76-1.20; P = .71). No serious adverse events related to the use of the pneumatic device were noted.Interpretation: Continuous regulation of cuff pressure of the tracheal tube using a pneumatic device was not superior to routine care in preventing VAP in patients with severe trauma.Clinical trial registration: ClinicalTrials.gov; No.: NCT02534974; URL: www.clinicaltrials.gov.
Published: 2021
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35. Impact of a Quality Improvement Program on the Neurological Outcome of Patients with Traumatic Spinal Cord Injury: A Before-After Mono-Centric Study

Author: Paul Rooze, Karim Asehnoune, Antoine Roquilly, Brigitte Perrouin-Verbe, Marwan Bouras, Marie-Anne Vibet, Raphaël Cinotti, Kevin Buffenoir, Pierre Joachim Mahe, Dominique Demeure-Dit-Latte, Nicolas Grillot, Paul Langlais, and Alexandre Bourdiol
Subjects: Adult, Male, 030506 rehabilitation, medicine.medical_specialty, Quality management, Traumatic spinal cord injury, medicine.medical_treatment, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Physical medicine and rehabilitation, medicine, Humans, Severe disability, Spinal cord injury, Spinal Cord Injuries, Aged, Rehabilitation, business.industry, Length of Stay, Middle Aged, medicine.disease, Quality Improvement, Respiration, Artificial, Intensive Care Units, Treatment Outcome, Cervical Vertebrae, Female, Neurology (clinical), Nervous System Diseases, 0305 other medical science, business, 030217 neurology & neurosurgery
Abstract: Spinal cord injury (SCI) is a major cause of severe disability. This study aims to assess the effectiveness of a quality improvement program on neurological recovery after SCI. Before-after study during two phases was done in one intensive care unit in a university hospital. The quality improvement project comprised protective mechanical ventilation, early tracheostomy in anatomical injury above the sixth cervical vertebra, early enteral nutrition, early mobilization, and active perineal care in adult SCI patients. The primary endpoint was the difference between the American Spinal Injury Association (ASIA) motor score between discharge and intensive care unit (ICU) admission (Delta ASIA). Fifty-seven and 60 patients were included in the control and in the intervention period respectively. The ASIA motor score upon ICU admission was 16 (7-37) before and 11 (2-30) after the implementation (
Published: 2019
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36. Diuretics decrease fluid balance in patients on invasive mechanical ventilation: the randomized-controlled single blind, IRIHS study

Author: Pierre-Joachim Mahé, Jean-Pierre Quenot, Jean Reignier, Karim Asehnoune, Aurelie Gaultier, Gwenhael Colin, Raphaël Cinotti, Marie-Ange Azais, Antoine Roquilly, and Jean-Baptiste Lascarrou
Subjects: Adult, Male, medicine.medical_treatment, Hemodynamics, Weaning, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Mechanical ventilation, Furosemide, medicine, Diuretic, Humans, In patient, Single-Blind Method, 030212 general & internal medicine, Diuretics, Balance (ability), business.industry, Research, Acute kidney injury, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Middle Aged, Water-Electrolyte Balance, medicine.disease, Respiration, Artificial, Fluid balance, Intensive Care Units, Anesthesia, Female, France, business, medicine.drug
Abstract: Background Fluid overload has been associated with increased morbidity and mortality in critically ill patients. The goal of this study was to assess the efficacy and safety of a diuretic strategy to overcome positive fluid balance in patients on invasive mechanical ventilation. Methods Design: Multicenter, single-blind, randomized-controlled study. Patients were randomized into a diuretic (furosemide) or a control group. Patients were eligible in case of fluid overload defined as in-ICU weight increase ≥ 3%, invasive mechanical ventilation (FiO2 ≤ 60% and PEEP ≤ 10 cm H2O on inclusion) and hemodynamic stabilization. The primary outcome was fluid balance, defined as weight variation from reference weight to successful extubation. The main secondary outcome was the safety of diuretic. Results 171 patients were randomized. After 5 exclusions, 166 patients were included in the analysis: 77 in the diuretic and 89 in the control group. Fluid balance was 1.4 [− 2.5 to 4.5] kg in the diuretic and 6.4 [0.5–11.2] kg in the control group (p p p = 0.5). There was a worsening of Acute Kidney Injury in 67 (75.3%) patients of the control group versus 46 (59.7%) patients in the diuretic group (p = 0.03). Conclusions In this multicenter randomized-controlled study, protocolized diuretic therapy reduced fluid accumulation in patients receiving mechanical ventilation and was well tolerated with a favorable safety profile. Trial registration NCT 02345681, Registered January 26 2015, Prospectively registered, https://clinicaltrials.gov/ct2/show/NCT02345681?term=02345681&draw=2&rank=1.
Published: 2021

37. Readmission following both cardiac and non-cardiac acute dyspnoea is associated with a striking risk of death

Author: Nikola Kozhuharov, Aušra Kavoliūnienė, Loreta Bagdonaitė, Julia Dinort, Eglė Palevičiūtė, Kamilė Čerlinskaitė, Dovilė Vaičiulienė, Irina Alitoit‐Marrote, Vytautas Juknevičius, Eleni Michou, Raphaël Cinotti, Christian Mueller, Danielle Menosi Gualandro, Šarūnas Damalakas, Alexandre Mebazaa, Kęstutis Stašaitis, Desiree Wussler, Mindaugas Balčiūnas, Jelena Čelutkienė, Justina Motiejūnaitė, Denis Kablučko, Aleksandras Laucevičius, Michael A. Matthay, Ieva Jonauskienė, Etienne Gayat, and Audrys Kukulskis
Subjects: medicine.medical_specialty, acute dyspnoea, acute heart failure, emergency department, mortality, readmission, vulnerable phase, 030204 cardiovascular system & hematology, Patient Readmission, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Original Research Articles, Internal medicine, medicine, Humans, Diseases of the circulatory (Cardiovascular) system, In patient, Original Research Article, 030212 general & internal medicine, Mortality, Acute dyspnoea, Heart Failure, business.industry, Proportional hazards model, Emergency department, Hazard ratio, Acute heart failure, medicine.disease, Confidence interval, Hospitalization, Dyspnea, Heart failure, RC666-701, Vulnerable phase, Etiology, Risk of death, Cardiology and Cardiovascular Medicine, business, Readmission
Abstract: Aims Readmission and mortality are the most common and often combined endpoints in acute heart failure (AHF) trials, but an association between these two outcomes is poorly investigated. The aim of this study was to determine whether unplanned readmission is associated with a greater subsequent risk of death in patients with acute dyspnoea due to cardiac and non‐cardiac causes. Methods and results Derivation cohort (1371 patients from the LEDA study) and validation cohort (1986 patients from the BASEL V study) included acute dyspnoea patients admitted to the emergency department. Cox regression analysis was used to determine the association of 6 month readmission and the risk of 1 year all‐cause mortality in AHF and non‐AHF patients and those readmitted due to cardiovascular and non‐cardiovascular causes. In the derivation cohort, 666 (49%) of patients were readmitted at 6 months and 282 (21%) died within 1 year. Six month readmission was associated with an increased 1 year mortality risk in both the derivation cohort [adjusted hazard ratio (aHR) 3.0 (95% confidence interval, CI 2.2–4.0), P
Published: 2021

38. Mechanical ventilation in patients with acute brain injury: recommendations of the European Society of Intensive Care Medicine consensus

Author: Chiara Robba, Jordi Mancebo, Arturo Chieregato, Ari Ercole, Nicole P. Juffermans, Jose I. Suarez, Ary Serpa Neto, David B. Seder, Molly McNett, Alejandro A. Rabinstein, Nicolás Nin, Raphaël Cinotti, Nicolas Bruder, Robert Stevens, Karim Asehnoune, Pedro Kurtz, Mauro Oddo, Mathieu van der Jagt, Giuseppe Citerio, Sharon Einav, Claude Guérin, Daniele Poole, Paolo Pelosi, Ilias I. Siempos, Fabio Silvio Taccone, Julian Bösel, L Mascia, Victoria A. McCredie, Jacques Duranteau, Markus B. Skrifvars, Niall D. Ferguson, Robba C., Poole D., McNett M., Asehnoune K., Bosel J., Bruder N., Chieregato A., Cinotti R., Duranteau J., Einav S., Ercole A., Ferguson N., Guerin C., Siempos I.I., Kurtz P., Juffermans N.P., Mancebo J., Mascia L., McCredie V., Nin N., Oddo M., Pelosi P., Rabinstein A.A., Neto A.S., Seder D.B., Skrifvars M.B., Suarez J.I., Taccone F.S., van der Jagt M., Citerio G., Stevens R.D., Robba, C, Poole, D, Mcnett, M, Asehnoune, K, Bösel, J, Bruder, N, Chieregato, A, Cinotti, R, Duranteau, J, Einav, S, Ercole, A, Ferguson, N, Guerin, C, Siempos, I, Kurtz, P, Juffermans, N, Mancebo, J, Mascia, L, Mccredie, V, Nin, N, Oddo, M, Pelosi, P, Rabinstein, A, Neto, A, Seder, D, Skrifvars, M, Suarez, J, Taccone, F, van der Jagt, M, Citerio, G, Stevens, R, Citerio, Giuseppe [0000-0002-5374-3161], Apollo - University of Cambridge Repository, Intensive Care, Intensive Care Medicine, HUS Emergency Medicine and Services, Department of Diagnostics and Therapeutics, University of Helsinki, and Helsinki University Hospital Area
Subjects: medicine.medical_specialty, Consensus, Critical Care, PREDICTION, Conference Reports and Expert Panel, medicine.medical_treatment, Psychological intervention, RESPIRATORY-DISTRESS-SYNDROME, Respiratory failure, Critical Care and Intensive Care Medicine, ACUTE LUNG INJURY, law.invention, 03 medical and health sciences, Mechanical ventilation, Traumatic brain injury, 0302 clinical medicine, law, Anesthesiology, ARDS, Acute stroke, Subarachnoid hemorrhage, medicine, Humans, Grading (education), Intensive care medicine, OUTCOMES, business.industry, Mechanical ventilation, Respiratory failure, ARDS, Traumatic brain injury, Acute stroke, Subarachnoid hemorrhage, Neurointensive care, 030208 emergency & critical care medicine, 3126 Surgery, anesthesiology, intensive care, radiology, Respiration, Artificial, Intensive care unit, 3. Good health, Intensive Care Units, 030228 respiratory system, TIDAL VOLUMES, Brain Injuries, Airway management, business
Abstract: Purpose To provide clinical practice recommendations and generate a research agenda on mechanical ventilation and respiratory support in patients with acute brain injury (ABI). Methods An international consensus panel was convened including 29 clinician-scientists in intensive care medicine with expertise in acute respiratory failure, neurointensive care, or both, and two non-voting methodologists. The panel was divided into seven subgroups, each addressing a predefined clinical practice domain relevant to patients admitted to the intensive care unit (ICU) with ABI, defined as acute traumatic brain or cerebrovascular injury. The panel conducted systematic searches and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was used to evaluate evidence and formulate questions. A modified Delphi process was implemented with four rounds of voting in which panellists were asked to respond to questions (rounds 1–3) and then recommendation statements (final round). Strong recommendation, weak recommendation, or no recommendation were defined when > 85%, 75–85%, and
Published: 2020

39. Early use of barbiturates is associated with increased mortality in traumatic brain injury patients from a propensity score-based analysis of a prospective cohort

Author: Maxime, Léger, Denis, Frasca, Antoine, Roquilly, Philippe, Seguin, Raphaël, Cinotti, Claire, Dahyot-Fizelier, Karim, Asehnoune, Florent, Le Borgne, Thomas, Gaillard, Yohann, Foucher, Sigismond, Lasocki, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Nantes Université - UFR des Sciences Pharmaceutiques et Biologiques (Nantes Université - UFR Pharmacie), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Pontchaillou [Rennes], Pharmacologie des anti-infectieux et antibiorésistance (PHAR2), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, IDBC/A2com [Pace, France], and Chauzy, Alexia
Subjects: [SDV] Life Sciences [q-bio], [SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences, Multidisciplinary, [SDV]Life Sciences [q-bio], Barbiturates, Brain Injuries, Traumatic, Humans, Pneumonia, Ventilator-Associated, Glasgow Coma Scale, Prospective Studies, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, Intracranial Hypertension, Propensity Score
Abstract: International audience; Barbiturates are proposed as a second/third line treatment for intracranial hypertension in traumatic brain injury (TBI) patients, but the literature remains uncertain regarding their benefit/risk balance. We aimed to evaluate the impact of barbiturates therapy in TBI patients with early intracranial hypertension on the intensive care unit (ICU) survival, the occurrence of ventilator-associated pneumonia (VAP), and the patient’s functional status at three months. We used the French AtlanREA prospective cohort of trauma patients. Using a propensity score-based methodology (inverse probability of treatment weighting), we compared patients having received barbiturates within the first 24 hours of admission (barbiturates group) and those who did not (control group). We used cause-specific Cox models for ICU survival and risk of VAP, and logistic regression for the 3-month Glasgow Outcome Scale (GOS) evaluation. Among the 1396 patients with severe trauma, 383 had intracranial hypertension on admission and were analyzed. Among them, 96 (25.1%) received barbiturates. The early use of barbiturates was significantly associated with increased ICU mortality (HR = 1.85, 95%CI 1.03–3.33). However, barbiturates treatment was not significantly associated with VAP (HR = 1.02, 95%CI 0.75–1.41) or 3-month GOS (OR = 1.67, 95%CI 0.84–3.33). Regarding the absence of relevant clinical trials, our results suggest that each early prescription of barbiturates requires a careful assessment of the benefit/risk ratio.
Published: 2020
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40. Incidence and predicting factors of perioperative complications during monitored anesthesia care for awake craniotomy

Author: Timothée Abaziou, Fouad Marhar, Rémi Menut, Diane Osinski, Louis Delamarre, David Brauge, Raphaël Cinotti, Olivier Fourcade, Jean-Christophe Sol, Franck-Emmanuel Roux, Francis Tincres, Claire Larcher, Thomas Geeraerts, Ségolène Mrozek, CHU Toulouse [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Centre de recherche cerveau et cognition (CERCO), Institut des sciences du cerveau de Toulouse. (ISCT), Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), and Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Bradycardia, business.industry, [SDV]Life Sciences [q-bio], Remifentanil, Retrospective cohort study, Odds ratio, Perioperative, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, Respiratory failure, 030202 anesthesiology, Anesthesia, Post-anesthesia care unit, medicine, medicine.symptom, business, Complication, 030217 neurology & neurosurgery, medicine.drug
Abstract: Study objective To assess incidence and predicting factors of awake craniotomy complications. Design Retrospective cohort study. Setting Operating room and Post Anesthesia Care unit. Patients 162 patients who underwent 188 awake craniotomy procedures for brain tumor, ASA I to III, with monitored anesthesia care. Measurements We classified procedures in 3 groups: major event group, minor event group, and no event group. Major events were defined as respiratory failure requiring face mask or invasive ventilation; hemodynamic instability treated by vasoactive drugs, or bradycardia treated by atropine, bleeding >500 ml, transfusion, gaseous embolism, cardiac arrest; seizure, cerebral edema, or any events leading to stopping of the cerebral mapping. Minor event was defined as any complication not classified as major. Multivariate logistic regression was used to determine predicting factors of major complication, adjusted for age and ASA score. Main results 45 procedures (24%) were classified in major event group, 126 (67%) in minor event group, and 17 (9%) in no event group. Seizure was the main complication (n = 13). Asthma (odds ratio: 10.85 [1.34; 235.6]), Remifentanil infusion (odds ratio: 2.97 [1.08; 9.85]) and length of the operation after the brain mapping (odds ratio per supplementary minute: 1.01 [1.01; 1.03]) were associated with major events. Conclusions Previous medical history of asthma, remifentanil infusion and a long duration of neurosurgery after cortical mapping appear to be risk factors for major complications during AC.
Published: 2020
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41. Consultation systématique après l’hospitalisation en soins intensifs pour le dépistage et la prise en charge du syndrome post-réanimation

Author: Raphaël Cinotti, Maxime Le Courtois du Manoir, Karim Asehnoune, and Hôtel-Dieu
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030228 respiratory system, [SDV]Life Sciences [q-bio], 030208 emergency & critical care medicine, 3. Good health
Abstract: Resume La population des patients « survivants » a une hospitalisation en soins intensifs croit dans de nombreux pays. Il peut persister des sequelles importantes, physiques, psychiques ou cognitives regroupees sous le nom de « syndrome post-reanimation », persistant a plus ou moins longue echeance. Ce syndrome est lourd de consequences sur le plan individuel et societal. Le diagnostic et la prise en charge de ses sequelles sont par consequent un enjeu medical majeur. Le medecin reanimateur peut jouer un role cle dans l’identification et la prise en charge de ce syndrome. A l’heure actuelle, il existe des recommandations sur cette prise en charge dans quelques pays europeens, mais pas en France. Des initiatives locales ont ete identifiees, mais l’absence de suivi systematise apres les soins intensifs reste le cas le plus frequent. Pour repondre a ce manque de donnees dans le suivi des patients apres la reanimation, nous rapportons notre experience dans la mise en place d’une evaluation systematique d’une cohorte de patients de reanimation chirurgicale, a 6 mois de leur hospitalisation. Les ecueils et difficultes rencontres au cours de l’elaboration de cette filiere sont rapportes ici et pourraient aider a l’organisation de ce type de consultations dans differents services.
Published: 2020
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42. Improved cardiac and venous pressures during hospital stay in patients with acute heart failure: an echocardiography and biomarkers study

Author: Alain Cohen-Solal, Jean-Marie Launay, Carolyn S.P. Lam, Rui Plácido, Alexandre Mebazaa, Faiez Zannad, Nicolas Girerd, Kamilė Čerlinskaitė, Patrick Rossignol, Marc Badoz, Raphaël Cinotti, Marie-France Seronde, Gad Cotter, Wilfried Mullens, Jeffrey M. Testani, Lucas Van Aelst, Eiichi Akiyama, Etienne Gayat, Mattia Arrigo, Tahar Chouihed, Arrigo, Mattia/0000-0003-4028-2869, Placido, Rui/0000-0003-4164-5481, Cardiovascular Centre (CVC), BOZEC, Erwan, Combattre l'insuffisance cardiaque - - FIGHT-HF2015 - ANR-15-RHUS-0004 - RHUS - VALID, The MEtabolic Road to DIAstolic Heart Failure - MEDIA - - EC:FP7:HEALTH2011-01-01 - 2016-06-30 - 261409 - VALID, Division of Cardiology, Yokohama City University Medical Center, 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, Centre hospitalier universitaire de Nantes (CHU Nantes), Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), Service de cardiologie (APHP-Hôpital Lariboisière), Hôpital Lariboisière-APHP, Department of Cardiology, University Heart Center, University Hospital Zurich, Département d’Anesthésie-Réanimation-SMUR [Hôpital Lariboisière], Hôpitaux Universitaire Saint-Louis, Lariboisière, Fernand-Widal, Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, and Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, 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), UFR de Médicine, Sorbonne Paris Cité, Paris Diderot University, Paris, Service d’Accueil des urgences [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), Department of Cardiology, University Hospital Jean Minjoz, Department of Medical Biochemistry and Molecular Biology, Hôpital Lariboisière, Center for Biological Resources BB-033-00064, Hôpital Lariboisière, Université Sorbonne Paris Cité (USPC), Department of Cardiology, Hôpitaux Universitaires Saint Louis-Lariboisière, Assistance Publique des Hopitaux de Paris, National Heart Centre Singapore (NHCS), Duke-National University of Singapore Graduate Medical School, University Medical Center Groningen [Groningen] (UMCG), Yale School of Medicine [New Haven, Connecticut] (YSM), Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Hasselt University (UHasselt), Momentum Research Inc., Durham, Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisiere, Assistance Publique des Hopitaux de Paris, This study was supported by a grant from the European Union funded by the Seventh Framework Programme for Health in 2010 (FP7-HEALTH-2010-MEDIA, Luxembourg) (F.Z., P.R., A. M) and research fellowship from Japan Heart Foundation (E. A.). P.R., N.G., T.C., and F.Z. are supported by a public grant overseen by the French National Research Agency (ANR) as part of the second 'Investissements d’Avenir' programmes Fighting Heart Failure (reference: ANR-15-RHU-0004), GEENAGE Impact Lorraine Université d’Excellence and by the Contrat de Plan Etat Région Lorraine IT2MP and FEDER Lorraine., IMPACT GEENAGE, ANR-15-RHUS-0004,FIGHT-HF,Combattre l'insuffisance cardiaque(2015), European Project: 261409,EC:FP7:HEALTH,FP7-HEALTH-2010-single-stage,MEDIA(2011), Repositório da Universidade de Lisboa, 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, Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology, KU Leuven, UFR de Médecine - Sorbonne Paris Cité (Université Paris Diderot - Paris 7 - UPD7), Université Paris Diderot - Paris 7 (UPD7)-Sorbonne Université (SU), and Yale University School of Medicine
Subjects: Cardiac output, lcsh:Diseases of the circulatory (Cardiovascular) system, Cardiac & Cardiovascular Systems, Cardiac index, 030204 cardiovascular system & hematology, Heart fail- ure with reduced ejection fraction, Ventricular Function, Left, RECOMMENDATIONS, CONGESTION, 0302 clinical medicine, MARKERS, Original Research Articles, Original Research Article, 030212 general & internal medicine, OUTCOMES, Ejection fraction, Diastolic heart failure, ASSOCIATION, Prognosis, Heart failure with reduced ejection fraction, EUROPEAN-SOCIETY, 3. Good health, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Heart failure with preserved ejection fraction, medicine.vein, Echocardiography, Cardiology, Congestion, Cardiology and Cardiovascular Medicine, Life Sciences & Biomedicine, medicine.medical_specialty, RENAL-FUNCTION, Renal function, PULMONARY-EDEMA, Inferior vena cava, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, SOLUBLE CD146, medicine, Humans, PLASMA-VOLUME, acute heart failure, biomarker, congestion, echocardiography, heart failure with preserved ejection fraction, heart failure with reduced ejection fraction, Heart Failure, Science & Technology, business.industry, Acute heart failure, Stroke Volume, Biomarker, Length of Stay, medicine.disease, lcsh:RC666-701, Heart failure, Cardiovascular System & Cardiology, business, Venous Pressure, Biomarkers
Abstract: © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution-Non Commercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes., Aims: Changes in echocardiographic parameters and biomarkers of cardiac and venous pressures or estimated plasma volume during hospitalization associated with decongestive treatments in acute heart failure (AHF) patients with either preserved left ventricular ejection fraction (LVEF) (HFPEF) or reduced LVEF (HFREF) are poorly assessed. Methods and results: From the metabolic road to diastolic heart failure: diastolic heart failure (MEDIA‐DHF) study, 111 patients were included in this substudy: 77 AHF (43 HFPEF and 34 HFREF) and 34 non‐cardiac dyspnea patients. Echocardiographic measurements and blood samples were obtained within 4 h of presentation at the emergency department and before hospital discharge. In AHF patients, echocardiographic indices of cardiac and venous pressures, including inferior vena cava diameter [from 22 (16–24) mm to 13 (11–18) mm, P = 0.009], its respiratory variability [from 32 (8–44) % to 43 (29–70) %, P = 0.04], medial E/e' [from 21.1 (15.8–29.6) to 16.6 (11.7–24.3), P = 0.004], and E wave deceleration time [from 129 (105–156) ms to 166 (128–203) ms, P = 0.003], improved during hospitalization, similarly in HFPEF and HFREF patients. By contrast, no changes were seen in non‐cardiac dyspnea patients. In AHF patients, all plasma biomarkers of cardiac and venous pressures, namely B‐type natriuretic peptide [from 935 (514–2037) pg/mL to 308 (183–609) pg/mL, P < 0.001], mid‐regional pro‐atrial natriuretic peptide [from 449 (274–653) pmol/L to 366 (242–549) pmol/L, P < 0.001], and soluble CD‐146 levels [from 528 (406–654) ng/mL to 450 (374–529) ng/mL, P = 0.003], significantly decreased during hospitalization, similarly in HFPEF and HFREF patients. Echocardiographic parameters of cardiac chamber dimensions [left ventricular end‐diastolic volume: from 120 (76–140) mL to 118 (95–176) mL, P = 0.23] and cardiac index [from 2.1 (1.6–2.6) mL/min/m2 to 1.9 (1.4–2.4) mL/min/m2, P = 0.55] were unchanged in AHF patients, except tricuspid annular plane systolic excursion (TAPSE) that improved during hospitalization [from 16 (15–19) mm to 19 (17–21) mm, P = 0.04]. Estimated plasma volume increased in both AHF [from 4.8 (4.2–5.6) to 5.1 (4.4–5.8), P = 0.03] and non‐cardiac dyspnea patients (P = 0.01). Serum creatinine [from 1.18 (0.90–1.53) to 1.19 (0.86–1.70) mg/dL, P = 0.89] and creatinine‐based estimated glomerular filtration rate [from 59 (40–75) mL/min/1.73m2 to 56 (38–73) mL/min/1.73m2, P = 0.09] were similar, while plasma cystatin C [from 1.50 (1.20–2.27) mg/L to 1.78 (1.33–2.59) mg/L, P < 0.001] and neutrophil gelatinase associated lipocalin (NGAL) [from 127 (95–260) ng/mL to 167 (104–263) ng/mL, P = 0.004] increased during hospitalization in AHF. Conclusions: Echocardiographic parameters and plasma biomarkers of cardiac and venous pressures improved during AHF hospitalization in both acute HFPEF and HFREF patients, while cardiac chamber dimensions, cardiac output, and estimated plasma volume showed minimal changes., This study was supported by a grant from the European Union funded by the Seventh Framework Programme for Health in 2010 (FP7-HEALTH-2010-MEDIA; Luxembourg) (F.Z., P.R., A. M) and research fellowship from Japan Heart Foundation (E. A.). P.R., N.G., T.C., and F.Z. are supported by a public grant overseen by the French National Research Agency (ANR) as part of the second “Investissements d’Avenir” programmes Fighting Heart Failure (reference: ANR-15-RHU-0004), GEENAGE Impact Lorraine Université d’Excellence and by the Contrat de Plan Etat Lorraine IT2MP and FEDER Lorraine. LNLVA is supported by a training grant from the European Society of Cardiology (2015) and a travelling award from the International Society for Heart and Lung Transplantation (August 2015 and 2016). LNLVA gratefully acknowledges the financial support from the Fund for Cardiac Surgery through the Jacqueline Bernheim prize 2015.
Published: 2020
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43. Influence of mechanical ventilation and loading modifications on left ventricular global longitudinal strain in patients undergoing general anesthesia: a pilot study

Author: Raphaël Cinotti, Pierre Millour, Paul Rooze, Karim Asehnoune, Nicolas Grillot, and Thierry Le Tourneau
Subjects: Mechanical ventilation, Ejection fraction, Longitudinal strain, business.industry, medicine.medical_treatment, 030208 emergency & critical care medicine, Pilot Projects, Stroke Volume, Stroke volume, Systolic function, Surgical procedures, Anesthesia, General, Respiration, Artificial, Ventricular Function, Left, 03 medical and health sciences, Ventricular Dysfunction, Left, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, Anesthesia, Medicine, Humans, In patient, business, Normal range
Abstract: The modifications of left ventricular systolic function assessed with global longitudinal strain (GLS) after general anesthesia and invasive mechanical ventilation are poorly described.This was a single-center observational study. ASA I-II patients undergoing routine surgical procedures requiring anesthesia with invasive mechanical ventilation had serial trans-thoracic speckle-tracking echocardiography: at baseline, five minutes after anesthesia and invasive mechanical ventilation, one minute after passive leg raising and after extubation. The primary objective was to evaluate the modification of left ventricular systolic function, assessed with GLS, under anesthesia and mechanical ventilation. Secondary objectives were to evaluate the alterations of GLS after pre-load modifications with passive leg raising and after extubation.From November 2016 to July 2017, 27 patients were included. Baseline left ventricular ejection fraction (LVEF: 60% [56-63]) and GLS (-20.6% [-23.2/-19.2]) were within normal ranges. After anesthesia, LVEF was not altered but GLS showed a significant decrease (-18.2% [-20.4/-17.1], P0.05). After passive leg raising, GLS was significantly impaired compared with baseline (-17.6% [-19.7/-15], P0.05) and seven (26%) patients presented systolic function impairment (GLS-16%). GLS was similar to baseline after extubation (-21.7% [-23.1/-19.5], P0.05).Systolic function assessed with GLS is impaired after general anesthesia and invasive mechanical ventilation in patients without cardiovascular co-morbidities but remains within normal range.
Published: 2020

44. Extubation strategies in neuro-intensive care unit patients and associations with outcomes

Author: Daniel Agustin Godoy, Muhammed Elhadi, Mohan Gurjar, Ioakeimidou Aikaterini, Karim Asehnoune, Rafael Badenes, Ueno Yoshitoyo, Pablo Alvarez, Julio C Mijangos-Méndez, Victoria Mc Credie, Paolo Pelosi, Romain Piracchio, Callum Kaye, Syed Tariq Reza, Michael Piagnerelli, Abdurrahmaan Suei Elbuzidi, Raphaël Cinotti, Matthias Haenggi, Robert Stevens, Marcus J. Schultz, Intensive Care Medicine, ACS - Atherosclerosis & ischemic syndromes, ACS - Diabetes & metabolism, ACS - Pulmonary hypertension & thrombosis, and ACS - Microcirculation
Subjects: Mechanical ventilation, medicine.medical_specialty, business.industry, medicine.medical_treatment, Glasgow Coma Scale, 030208 emergency & critical care medicine, General Medicine, medicine.disease, Intensive care unit, law.invention, Clinical trial, Study Protocol, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, law, Emergency medicine, Cohort, medicine, Clinical endpoint, Observational study, business, Stroke
Abstract: Background Prolonged invasive ventilation is common in patients with severe brain injury. Information on optimal management of extubation and on the use of tracheostomy in these patients is scarce. International guidelines regarding the ventilator liberation and tracheostomy are currently lacking. Methods The aim of 'Extubation strategies in Neuro-Intensive care unit patients and associations with Outcomes' (ENIO) study is to describe current management of weaning from invasive ventilation, focusing on decisions on timing of tracheal extubation and tracheostomy in intensive care unit (ICU) patients with brain injury. We conducted a prospective, international, multi-centre observational study enrolling patients with various types of brain injury, including trauma, stroke, and subarachnoid haemorrhage, with an initial Glasgow Coma Score equal or less than 12, and a duration of invasive ventilation longer than 24 hours from ICU admission. ENIO is expected to include at least 1,500 patients worldwide. The primary endpoint of the ENIO study is extubation success in the 48 hours following endotracheal tube removal. The primary objective is to validate a score predictive of extubation success. To accomplish this, the study population will be randomly divided to a development cohort (2/3 of the included patients) and a validation cohort (the remaining 1/3). Secondary objectives are: to determine the incidence of extubation success rate according to various time-frames (within 96 hours, >96 hours after extubation); to validate (existing) prediction scores for successful extubation according to various time-frames and definitions (i.e., tracheostomy as extubation failure); and to describe the current practices of extubation and tracheostomy, and their associations. Discussion ENIO will be the largest prospective observational study of ventilator liberation and tracheostomy practices in patients with severe brain injury undergoing invasive mechanical ventilation, providing a validated predictive score of successful extubation. Trial registration The ENIO study is registered in the Clinical Trials database: NCT03400904.
Published: 2020
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45. A longitudinal cohort of stress cardiomyopathy assessed with speckle-tracking echocardiography after moderate to severe traumatic brain injury

Author: Kalyane Bach-Ngohou, Karim Asehnoune, Raphaël Cinotti, Thierry Le Tourneau, Maxime Le Courtois du Manoir, and Bertrand Rozec
Subjects: Moderate to severe, Adult, Male, medicine.medical_specialty, Traumatic brain injury, Cardiomyopathy, Speckle tracking echocardiography, Critical Care and Intensive Care Medicine, Cohort Studies, Takotsubo Cardiomyopathy, Internal medicine, Brain Injuries, Traumatic, medicine, Research Letter, Humans, Longitudinal cohort, business.industry, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Speckle-tracking echocardiography, Reproducibility of Results, lcsh:RC86-88.9, Middle Aged, medicine.disease, Echocardiography, Stress cardiomyopathy, Cardiology, Female, business
Published: 2020

46. Cortisol total/CRP ratio for the prediction of hospital-acquired pneumonia and initiation of corticosteroid therapy in traumatic brain-injured patients

Author: Karim Asehnoune, Mickael Vourc'h, Marwan Bouras, Damien Masson, Kalyane Bach-Ngohou, Bastien Perrot, Antoine Roquilly, Pierre-Joachim Mahé, Raphaël Cinotti, Surgical Intensive Care Unit [Nantes], Hôtel-Dieu de Nantes-Centre hospitalier universitaire de Nantes (CHU Nantes), Thérapeutiques cliniques et expérimentales des infections (EA 3826) (EA 3826), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Biochemistry Laboratory [Nantes], The Enteric Nervous System in gut and brain disorders [U1235] (TENS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Department of Anesthesia and Critical Care [Nantes], The French Society of Anesthesiology and Intensive care (SFAR) and institutional funds., Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, and Bodescot, Myriam
Subjects: Male, Traumatic, Letter, Hydrocortisone, Injury, Critical Care and Intensive Care Medicine, Hospital-acquired pneumonia, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Cortisol, law.invention, 0302 clinical medicine, Randomized controlled trial, Adrenal Cortex Hormones, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Brain Injuries, Traumatic, Odds Ratio, Corticosteroid, Medicine, 030212 general & internal medicine, [SDV.BBM.BC] Life Sciences [q-bio]/Biochemistry, Molecular Biology/Biochemistry [q-bio.BM], lcsh:Medical emergencies. Critical care. Intensive care. First aid, Brain, Middle Aged, Anti-Bacterial Agents, 3. Good health, [SDV.BBM.BC]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Biomolecules [q-bio.BM], Community-Acquired Infections, C-Reactive Protein, Corticosteroid therapy, [SDV.SP.PHARMA] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Female, medicine.symptom, CRP, Adult, medicine.medical_specialty, Adolescent, Traumatic brain injury, medicine.drug_class, Cortisol total, Lesion, 03 medical and health sciences, Double-Blind Method, stomatognathic system, Predictive Value of Tests, Internal medicine, Humans, [SDV.BBM.BC]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Biochemistry [q-bio.BM], Aged, Surrogate endpoint, business.industry, Research, Healthcare-Associated Pneumonia, Glasgow Coma Scale, lcsh:RC86-88.9, Pneumonia, medicine.disease, ROC Curve, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, business, 030217 neurology & neurosurgery, Biomarkers
Abstract: Background To propose a combination of blood biomarkers for the prediction of hospital-acquired pneumonia (HAP) and for the selection of traumatic brain-injured (TBI) patients eligible for corticosteroid therapy for the prevention of HAP. Methods This was a sub-study of the CORTI-TC trial, a multicenter, randomized, double-blind, controlled trial evaluating the risk of HAP at day 28 in 336 TBI patients treated or not with corticosteroid therapy. Patients were between 15 and 65 years with severe traumatic brain injury (Glasgow coma scale score ≤ 8 and trauma-associated lesion on brain CT scan) and were enrolled within 24 h of trauma. The blood levels of CRP and cortisoltotal&free, as a surrogate marker of the pro/anti-inflammatory response balance, were measured in samples collected before the treatment initiation. Endpoint was HAP on day 28. Results Of the 179 patients with available samples, 89 (49.7%) developed an HAP. Cortisoltotal&free and CRP blood levels upon ICU admission were not significantly different between patients with or without HAP. The cortisoltotal/CRP ratio upon admission was 2.30 [1.25–3.91] in patients without HAP and 3.36 [1.74–5.09] in patients with HAP (p = 0.021). In multivariate analysis, a cortisoltotal/CRP ratio > 3, selected upon the best Youden index on the ROC curve, was independently associated with HAP (OR 2.50, CI95% [1.34–4.64] p = 0.004). The HR for HAP with corticosteroid treatment was 0.59 (CI95% [0.34–1.00], p = 0.005) in patients with a cortisoltotal/CRP ratio > 3, and 0.89 (CI95% [0.49–1.64], p = 0.85) in patients with a ratio Conclusion A cortisoltotal/CRP ratio > 3 upon admission may predict the development of HAP in severe TBI. Among these patients, corticosteroids reduce the occurrence HAP. We suggest that this ratio may select the patients who may benefit from corticosteroid therapy for the prevention of HAP.
Published: 2020
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47. Feasibility and impact of the implementation of a clinical scale-based sedation-analgesia protocol in severe burn patients undergoing mechanical ventilation. A before-after bi-center study

Author: Kada Klouche, Karim Asehnoune, Raphaël Cinotti, Antoine Roquilly, Farid Bekara, Boris Jung, Romaric Larcher, Pierre-Joachim Mahe, Luc Desmedt, Noémie Besnard, Pierre Perrot, Ronan Le Floch, Denis Frasca, Hôtel-Dieu de Nantes, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Sarcomes osseux et remodelage des tissus calcifiés - Phy-Os [Nantes - INSERM U1238] (Phy-Os), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Bretagne Loire (UBL)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Hôpital Lapeyronie [Montpellier] (CHU), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Surgical Intensive Care Unit [Nantes], Hôtel-Dieu de Nantes-Centre hospitalier universitaire de Nantes (CHU Nantes), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre hospitalier universitaire de Nantes (CHU Nantes), Sarcomes osseux et remodelage des tissus calcifiés - Phy-Os [Nantes] (INSERM U1238), Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), and MORNET, Dominique
Subjects: Male, Time Factors, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], medicine.medical_treatment, [SDV]Life Sciences [q-bio], Clinical scale, Pregabalin, Nurses, Pain, Procedural, Critical Care and Intensive Care Medicine, Hypnotic, 030207 dermatology & venereal diseases, 0302 clinical medicine, Mechanical ventilation, Clinical Protocols, Hypnotics and Sedatives, Infusions, Intravenous, ComputingMilieux_MISCELLANEOUS, Pain Measurement, musculoskeletal, neural, and ocular physiology, General Medicine, Middle Aged, 3. Good health, Analgesics, Opioid, Anesthesia, Sedation, Emergency Medicine, Female, Ketamine, medicine.symptom, Burns, Ventilator Weaning, Oxycodone, medicine.drug, Adult, medicine.drug_class, Midazolam, Pain, macromolecular substances, Weaning, Remifentanil, 03 medical and health sciences, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Humans, Pain Management, Severe burn, Dose-Response Relationship, Drug, business.industry, Significant difference, 030208 emergency & critical care medicine, Respiration, Artificial, Opioid, nervous system, Controlled Before-After Studies, Feasibility Studies, Surgery, Analgesia, business
Abstract: Background Severe burn patients undergo prolonged administration of sedatives and analgesics for burn care. There are currently no guidelines for the dose adaptation of sedation-analgesia in severe burn patients. Methods We performed a before-after 2-center study to demonstrate the feasibility and efficacy of a sedation-analgesia scale-based protocol in severely burned patients receiving ≥24 h of invasive mechanical ventilation. Before the intervention, continuous infusion of hypnotic and morphine derivatives was continued. During the Intervention phase, general anesthesia was relayed from day 1 by RASS/BPS-titrated continuous infusion of hypnotic and morphine derivatives and with short half-life drugs adminstered for daily burn dressings. The primary outcome was the duration of invasive mechanical ventilation in the ICU. Results Eighty-seven (46.2%) patients were included in the Control phase and 101 (53.7%) in the Intervention phase. The median burned cutaneous surface was 20% [11%–38%] and median ABSI was 7 [5–9]. The durations of hypnotic and opioid infusions were not statistically different between the 2 phases (8 days [2–24] vs. 6 days [2–17] (P = 0.3) and 17 days [4–32] vs. 8 days [3–23] (P = 0.06), respectively). The duration of mechanical ventilation was 14 days [3-29] in the Control phase and 7 days [2–24] in the Intervention phase (P = 0.7). When taking into account the competition between mortality and weaning from mechanical ventilation, we found no significant difference between the 2 phases (Gray test, P = 0.4). The time-series analysis showed no difference for the duration of mechanical ventilation in the Intervention phase (P = 0.6). Eighteen (20.7%) patients died in the Control phase, and 18 (18%) in the Intervention phase (P = 0.6). Conclusion Scale-based lightening of continuous sedation-analgesia with repeated short general anesthesia for dressing is feasible in severe burn patients but failed to demonstrate a decrease in the duration of invasive mechanical ventilation.
Published: 2020
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48. Alveolar macrophages are epigenetically altered after inflammation, leading to long-term lung immunoparalysis

Author: Mickael Vourc'h, Marion Davieau, Jose A Villadangos, Antoine Roquilly, Hamish E G McWilliam, Vanessa Gauttier, Abderrahmane Sadek, Raphaël Cinotti, Alexis Broquet, Cédric Jacqueline, Cynthia Fourgeux, Alice Molle, Frédéric Altare, Nadege Marec, Karim Asehnoune, Jeremie Poschmann, Paul Rooze, Barbara Misme-Aucouturier, Tanguy Chaumette, Le Bihan, Sylvie, Thérapeutiques cliniques et expérimentales des infections (EA 3826) (EA 3826), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Anesthésie Réanimation chirurgicale [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes)-Hôpital Guillaume-et-René-Laennec [Saint-Herblain], University of Melbourne, Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Institut de transplantation urologie-néphrologie (ITUN), Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes), Université Moulay Ismail (UMI), Plateforme CYTOCELL Nantes (CRCINA-CYTOCELL), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes), Host-Pathogen Interactions in the Regulation of Immune Responses (CRCINA-ÉQUIPE 5), Dendritic cells and immunoregulation in transplantation and immunopathology (Team 1 - U1064 Inserm - CRTI), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), and Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA)
Subjects: 0301 basic medicine, Phagocytosis, [SDV]Life Sciences [q-bio], Immunology, Inflammation, Systemic inflammation, Immune tolerance, Sepsis, 03 medical and health sciences, 0302 clinical medicine, medicine, Immunology and Allergy, Lung, biology, business.industry, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], Pneumonia, 030104 developmental biology, medicine.anatomical_structure, biology.protein, medicine.symptom, Antibody, business, 030215 immunology
Abstract: International audience; Sepsis and trauma cause inflammation and elevated susceptibility to hospital-acquired pneumonia. As phagocytosis by macrophages plays a critical role in the control of bacteria, we investigated the phagocytic activity of macrophages after resolution of inflammation. After resolution of primary pneumonia, murine alveolar macrophages (AMs) exhibited poor phagocytic capacity for several weeks. These paralyzed AMs developed from resident AMs that underwent an epigenetic program of tolerogenic training. Such adaptation was not induced by direct encounter of the pathogen but by secondary immunosuppressive signals established locally upon resolution of primary infection. Signal-regulatory protein α (SIRPα) played a critical role in the establishment of the microenvironment that induced tolerogenic training. In humans with systemic inflammation, AMs and also circulating monocytes still displayed alterations consistent with reprogramming six months after resolution of inflammation. Antibody blockade of SIRPα restored phagocytosis in monocytes of critically ill patients in vitro, which suggests a potential strategy to prevent hospital-acquired pneumonia.
Published: 2020
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49. Prediction Score for Postoperative Neurologic Complications after Brain Tumor Craniotomy

Author: Yvonnick Blanloeil, Mohamed Srairi, Anaïs Guéguen, Catherine Paugam-Burtz, Fanny Feuillet, Vincent Atthar, Karim Asehnoune, Aurélie Le Thuaut, Nicolas Bruder, Julien Pottecher, Thomas Geeraerts, Doris Vigouroux, Thibault Triglia, Julien Josserand, Bertrand Rozec, Hélène Beloeil, Michel Galliez, Raphaël Cinotti, Karim Lakhal, and Simon Viquesnel
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, Glasgow Coma Scale, MEDLINE, Intensive care unit, 3. Good health, law.invention, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, law, Predictive value of tests, Emergency medicine, Medicine, Observational study, business, Prospective cohort study, 030217 neurology & neurosurgery, Craniotomy, Cohort study
Abstract: Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Craniotomy for brain tumor displays significant morbidity and mortality, and no score is available to discriminate high-risk patients. Our objective was to validate a prediction score for postoperative neurosurgical complications in this setting. Methods Creation of a score in a learning cohort from a prospective specific database of 1,094 patients undergoing elective brain tumor craniotomy in one center from 2008 to 2012. The validation cohort was validated in a prospective multicenter independent cohort of 830 patients from 2013 to 2015 in six university hospitals in France. The primary outcome variable was postoperative neurologic complications requiring in–intensive care unit management (intracranial hypertension, intracranial bleeding, status epilepticus, respiratory failure, impaired consciousness, unexpected motor deficit). The least absolute shrinkage and selection operator method was used for potential risk factor selection with logistic regression. Results Severe complications occurred in 125 (11.4%) and 90 (10.8%) patients in the learning and validation cohorts, respectively. The independent risk factors for severe complications were related to the patient (Glasgow Coma Score before surgery at or below 14, history of brain tumor surgery), tumor characteristics (greatest diameter, cerebral midline shift at least 3 mm), and perioperative management (transfusion of blood products, maximum and minimal systolic arterial pressure, duration of surgery). The positive predictive value of the score at or below 3% was 12.1%, and the negative predictive value was 100% in the learning cohort. In–intensive care unit mortality was observed in eight (0.7%) and six (0.7%) patients in the learning and validation cohorts, respectively. Conclusions The validation of prediction scores is the first step toward on-demand intensive care unit admission. Further research is needed to improve the score’s performance before routine use.
Published: 2018
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50. Protective ventilation during anaesthesia reduces major postoperative complications after lung cancer surgery

Author: Samir Jaber, Jacques Jobard, Laurence Bérard, Dragos Radu, Vincent Piriou, Francis Bonnet, Raphaël Cinotti, Benoit Barrucand, and Emmanuel Marret
Subjects: Lung cancer surgery, business.industry, Incidence (epidemiology), respiratory system, 030204 cardiovascular system & hematology, respiratory tract diseases, 3. Good health, law.invention, Double blind, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, Randomized controlled trial, 030202 anesthesiology, law, Anesthesia, Medicine, Risk factor, Prospective cohort study, business, Tidal volume, Abdominal surgery
Abstract: BACKGROUNDThoracic surgery for lung resection is associated with a high incidence of postoperative pulmonary complications. Controlled ventilation with a large tidal volume has been documented to be a risk factor for postoperative respiratory complications after major abdominal surgery, whereas the
Published: 2018
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