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

Author: Lionel Velly, Etienne Gayat, Hervé Quintard, Emmanuel Weiss, Audrey De Jong, Philippe Cuvillon, Gérard Audibert, Julien Amour, Marc Beaussier, Matthieu Biais, Sébastien Bloc, Marie Pierre Bonnet, Pierre Bouzat, Gilles Brezac, Claire Dahyot-Fizelier, Souhayl Dahmani, Mathilde de Queiroz, Sophie Di Maria, Claude Ecoffey, Emmanuel Futier, Thomas Geeraerts, Haithem Jaber, Laurent Heyer, Rim Hoteit, Olivier Joannes-Boyau, Delphine Kern, Olivier Langeron, Sigismond Lasocki, Yoan Launey, Frederic le Saché, Anne Claire Lukaszewicz, Axel Maurice-Szamburski, Nicolas Mayeur, Fabrice Michel, Vincent Minville, Sébastien Mirek, Philippe Montravers, Estelle Morau, Laurent Muller, Jane Muret, Karine Nouette-Gaulain, Jean Christophe Orban, Gilles Orliaguet, Pierre François Perrigault, Florence Plantet, Julien Pottecher, Christophe Quesnel, Vanessa Reubrecht, Bertrand Rozec, Benoit Tavernier, Benoit Veber, Francis Veyckmans, Hélène Charbonneau, Isabelle Constant, Denis Frasca, Marc-Olivier Fischer, Catherine Huraux, Alice Blet, Marc Garnier, Assistance Publique - Hôpitaux de Marseille (APHM), Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP)-Université Sorbonne Paris Nord, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut de pharmacologie moléculaire et cellulaire (IPMC), Centre National de la Recherche Scientifique (CNRS)-Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service d'Anesthésie et Réanimation [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Cardiologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Mutualiste de Montsouris (IMM), Biologie des maladies cardiovasculaires = Biology of Cardiovascular Diseases, Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Neuro-imagerie fonctionnelle et métabolique (ANTE-INSERM U836, équipe 5), Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie-réanimation, Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Clermont-Ferrand, CHU Toulouse [Toulouse], Service Anesthésie - Réanimation [Bordeaux], CHU Bordeaux [Bordeaux], Physiopathologie et Pharmacologie Clinique de la Douleur, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Clinique Juge - Clinique du sport [Marseille], Pôle d'Anesthésie-Réanimation [CHU Rangueil], CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Hôpital de Rangueil, Hôpital de la Timone [CHU - APHM] (TIMONE), Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Département d'Anesthésie Réanimation, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Unité de réanimation médicale [CHU de Carémeau, Nîmes], Institut Curie [Paris], Réanimation Médico-Chirurgicale, Service d'Anesthésie Réanimation, CHU Necker - Enfants Malades [AP-HP], Département d'anesthésie-réanimation[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier], Mitochondries, stress oxydant et protection musculaire (Strasbourg), Mitochondrie, stress oxydant et protection musculaire (MSP), Université de Strasbourg (UNISTRA)-Université de Strasbourg (UNISTRA), Physiopathologie et Epidemiologie de l'Insuffisance Respiratoire, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Nantes (CHU Nantes), Service de soins intensifs [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Groupe d’Anesthésie-Réanimation Chirurgie cardio-thoracique et vasculaire [Toulouse], Clinique Pasteur [Toulouse], CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, Département d'anesthésiologie [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Physiopathologie et Epidémiologie des Maladies Respiratoires (PHERE (UMR_S_1152 / U1152)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Sorbonne Université (SU), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université de Rennes (UR)-Hôpital Pontchaillou, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Pôle Anesthésie Réanimation [CHU de Toulouse], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [CHU Montpellier], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Biomarqueurs CArdioNeuroVASCulaires (BioCANVAS), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015 - 2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015 - 2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS), Histoire et Cultures de l'Antiquité et du Moyen Âge (HISCANT-MA), Université de Lorraine (UL), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Emergency Department, Université Bordeaux Segalen - Bordeaux 2-Hôpital Pellegrin - Bordeaux, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM), Anaesthesiology, Robert Debré Hospital, Service d'anesthésie réanimation chirurgicale, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pitié-Salpêtrière [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital de Rangueil, Anthropologie bio-culturelle, Droit, Ethique et Santé (ADES), Aix Marseille Université (AMU)-EFS ALPES MEDITERRANEE-Centre National de la Recherche Scientifique (CNRS), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Physiopathologie mitochondriale, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherches sur les Herbivores - UMR 1213 (UMRH), Institut National de la Recherche Agronomique (INRA)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Laboratoire d'Anesthésiologie, Université Pierre et Marie Curie - Paris 6 (UPMC), and Department of Anesthesia, Burn and Critical Care, University Hospitals Saint-Louis - Lariboisière, AP-HP, Paris, France.
Subjects: Infection prevention and control, [SDV]Life Sciences [q-bio], Psychological intervention, Airway management, Context (language use), Critical Care and Intensive Care Medicine, Article, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, 030202 anesthesiology, Informed consent, Personal protective equipment, Pandemic, Health care, Medicine, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, Modalities, SARS-CoV-2, business.industry, COVID-19, 030208 emergency & critical care medicine, General Medicine, Guideline, 3. Good health, Anesthesiology and Pain Medicine, Universal precautions, Anesthesia, Viruses, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract: Objectives The world is currently facing an unprecedented healthcare crisis caused by the COVID-19 pandemic. The objective of these guidelines is to produce a framework to facilitate the partial and gradual resumption of intervention activity in the context of the COVID-19 pandemic. Methods The group has endeavoured to produce a minimum number of recommendations to highlight the strengths to be retained in the 7 predefined areas: (1) protection of staff and patients; (2) benefit/risk and patient information; (3) preoperative assessment and decision on intervention; (4) modalities of the preanaesthesia consultation; (5) specificity of anaesthesia and analgesia; (6) dedicated circuits and (7) containment exit type of interventions. Results The SFAR Guideline panel provides 51 statements on anaesthesia management in the context of COVID-19 pandemic. After one round of discussion and various amendments, a strong agreement was reached for 100% of the recommendations and algorithms. Conclusion We present suggestions for how the risk of transmission by and to anaesthetists can be minimised and how personal protective equipment policies relate to COVID-19 pandemic context.
Published: 2020
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2. Healthcare Associated Pneumonia in Intensive Care Unit

Author: Sami Hraiech, Jean-Ralph Zahar, Sébastien Gibot, Charles-Edouard Luyt, Antoine Roquilly, Gerald Chanques, Djamel Mokart, Lila Bouadma, Marc Leone, Dimitri Margetis, Fabrice Michel, Rémi Bruyère, Yoann Launey, Philippe Montravers, O. Brissaud, Stéphane Dauger, Saad Nseir, Antoine Monsel, Belaid Bouhemad, Lionel Velly, Jérôme Pugin, Eric Kipnis, Boris Jung, Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Institut Hospitalier Universitaire Méditerranée Infection (IHU AMU), CIC - CHU Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service d'anesthésie réanimation chirurgicale, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Service d'anesthésiologie et soins intensifs [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], CIC Lille, Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre hospitalier universitaire de Nantes (CHU Nantes), Institut de Biologie du Développement de Marseille (IBDM), Aix Marseille Université (AMU)-Collège de France (CdF)-Centre National de la Recherche Scientifique (CNRS), Service de réanimation - soins continus (Centre hospitalier de Bourg-en-Bresse), Centre Hospitalier de Bourg-en-Bresse, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Aix Marseille Université (AMU), Hôpital Nord [CHU - APHM], Service d'anesthésie - réanimation chirurgicale [CHU Bichat], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), 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), Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre d'Investigation Clinique - Innovation Technologique de Lille - CIC 1403 - CIC 9301 (CIC Lille), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'anesthésie et de réanimation [Hôpital de la Timone - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE), Département d'anesthésie-réanimation[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [CHU Montpellier], Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service d'Anesthésie réanimation [CHU Pitié-Salpêtrière], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier]
Subjects: [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, business.industry, Emergency Nursing, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 030228 respiratory system, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Emergency Medicine, Medicine, [SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology, 030212 general & internal medicine, business, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2019
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3. Does amnesia specifically predict Alzheimer's pathology? A neuropathological study

Author: Bertoux, Maxime, Cassagnaud, Pascaline, Lebouvier, Thibaud, Lebert, Florence, Sarazin, Marie, Le Ber, Isabelle, Dubois, Bruno, Bank, Brain, Auriacombe, Sophie, Hannequin, Didier, Wallon, David, Ceccaldi, Mathieu, Maurage, Claude-Alain, Deramecourt, Vincent, Pasquier, Florence, Lille Neurosciences & Cognition - U 1172 (LilNCog (ex-JPARC)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Neuro-anatomie fonctionnelle du comportement et de ses troubles, Université Pierre et Marie Curie - Paris 6 (UPMC)-IFR70-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Mémoire de Ressources et de Recherche [Nice] (CMRR Nice), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre Hospitalier Universitaire de Nice (CHU Nice)-Université Côte d'Azur (UCA), Service de neurologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Hôpital de la Timone [CHU - APHM] (TIMONE), Lille Neurosciences & Cognition - U 1172 (LilNCog), Université de Rennes (UR)-Hôpital Pontchaillou, Institut du Cerveau = Paris Brain Institute (ICM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Université Nice Sophia Antipolis (1965 - 2019) (UNS), and Bertoux, Maxime
Subjects: [SDV] Life Sciences [q-bio], [SDV.MHEP.AHA] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, [SCCO.NEUR]Cognitive science/Neuroscience, [SDV]Life Sciences [q-bio], [SDV.MHEP.PSM]Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health, [SCCO.NEUR] Cognitive science/Neuroscience, [SCCO.PSYC] Cognitive science/Psychology, [SDV.MHEP.PSM] Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health, [SCCO.PSYC]Cognitive science/Psychology, [SDV.MHEP.AHA]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; Amnesia is a key component of Alzheimer’s disease (AD) and the most important feature of its clinical diagnosis but its specificity has recently been challenged. This study investigated the ability of amnesia to predict AD in a clinicopathological dementia series. Ninety-one patients to which free and cued verbal memory assessment was administered during early cognitive decline, were followed until autopsy. Patients’ histological diagnoses were classified as pure-AD, mixed-AD and non-AD pathologies. Data-driven automated classification procedures explored the correspondence between memory performance and pathological diagnoses. Classifications revealed three clusters of performance reflecting different levels of amnesia. Little correspondence between these clusters and the presence of AD pathology was retrieved. A third of patients with pure/mixed AD pathology were non-amnesic at presentation and ≈45% of patients without AD pathology were amnesic. Data-driven prediction of AD pathology based on memory also had a poor accuracy. Free and cued memory assessments are fair tools to diagnose an amnesic syndrome but lack of accuracy to predict AD pathology.
Published: 2020

4. Role of bioclimate conditions on cerebral aneurysm rupture in the Brittany region of France

Author: Xavier Morandi, P.-J. Le Reste, Yoann Launey, G. Le Gac, Jean-Yves Gauvrit, Philippe Seguin, Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Service de neurochirurgie [Rennes] = Neurosurgery [Rennes], CHU Pontchaillou [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, and CCSD, Accord Elsevier
Subjects: Adult, Male, medicine.medical_specialty, Subarachnoid hemorrhage, Critical Care, Climate, Oceans and Seas, Aneurysm, Ruptured, law.invention, Aneurysm rupture, 03 medical and health sciences, 0302 clinical medicine, law, Humans, Medicine, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], cardiovascular diseases, Moon, Weather, ComputingMilieux_MISCELLANEOUS, Aged, Retrospective Studies, Air Pressure, business.industry, Temperature, Intracranial Aneurysm, Middle Aged, University hospital, medicine.disease, Intensive care unit, nervous system diseases, 3. Good health, Cold Temperature, 13. Climate action, 030220 oncology & carcinogenesis, Anesthesia, Female, Surgery, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], France, Seasons, Neurology (clinical), Neurosurgery, Temperature drop, business, 030217 neurology & neurosurgery, Cerebral aneurysm rupture
Abstract: Subarachnoid hemorrhage (SAH) from intracranial aneurysm rupture is an unpredictable event responsible for significant morbidity and mortality. Despite inconsistencies, some studies suggest a potential role of climate conditions in SAH onset. The purpose of this study was to determine the impact of climatic and lunar factors on onset of SAH in an oceanic climate such as that of Brittany, France.All adults with SAH admitted to the neurosurgery department and intensive care unit of the University Hospital of Rennes (France) between January 1st, 2011 and December 31st, 2012 were included. Meteorological variables, their variations, lunar phases and tidal coefficients were compared between days with and without SAH.We retrospectively included 295 patients with SAH. Mean minimum temperature was significantly lower during days with SAH (7.7±4.7°C versus 8.3±4.6°C; P=0.039); temperature variation between 2 successive days was significantly greater for days with SAH (8.6±4.1°C versus 7.9±3.8°C; P0.01). Multivariate analysis showed that a 2-day temperature drop greater than or equal to 8°C was associated with 35% increased risk of SAH (odds ratio 1.35 [1.03-1.77]). There were no significant effects of other meteorological variables, lunar phase or tidal coefficient on SAH occurrence.Low temperature and sudden temperature drop were associated with increased occurrence of SAH in Brittany, France.
Published: 2019
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5. Multicentre, open-label, randomised, controlled clinical trial comparing 2% chlorhexidine-70% isopropanol and 5% povidone iodine-69% ethanol for skin antisepsis in reducing surgical-site infection after cardiac surgery: the CLEAN 2 study protocol

Author: Boisson, Matthieu, Corbi, Pierre, Kerforne, Thomas, Camilleri, Lionel, Debauchez, Mathieu, Demondion, Pierre, Eljezi, Vedat, Flecher, Erwan, Lepelletier, Didier, Leprince, Pascal, Nesseler, Nicolas, Nizou, Jacques Yves, Roussel, Jean Christian, Rozec, Bertrand, Ruckly, Stéphane, Lucet, Jean-Christophe, Timsit, Jean-François, Mimoz, Olivier, Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie réanimation [Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), CHU Poitiers, Service de chirurgie cardio-thoracique, Poitiers, 86000, France, Service de chirurgie cardiaque, CHU Clermont-Ferrand, Institut Mutualiste de Montsouris (IMM), Service de Chirurgie Thoracique et Cardiovasculaire [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Département Anesthésie et Réanimation, Hôpital Estaing, Université Clermont Auvergne, Service de chirurgie thoracique cardiaque et vasculaire [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service de Bactériologie - Hygiène Hospitalière [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Département d'anesthésie réanimation [Rennes], Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes], Département de chirurgie thoracique et cardiovasculaire [CHU Nantes], Unité de Soins Intensifs [CHU Nantes] (Département d'anesthésie et de soins intensifs), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Sorbonne Paris Nord, Hôpital Bichat - Claude Bernard, Services de Maladies Infectieuses et Tropicales [CHU Bichat], AP-HP - Hôpital Bichat - Claude Bernard [Paris], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service d'Anésthésie Réanimation [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], CHU Pontchaillou [Rennes], Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Chirurgie cardiaque et thoracique [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), HAL UR1, Admin, Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Pontchaillou-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)
Subjects: surgical-site infection, Ethanol, povidone iodine, Administration, Topical, [SDV]Life Sciences [q-bio], chlorhexidine, Antisepsis, skin antisepsis, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, 2-Propanol, [SDV] Life Sciences [q-bio], [SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences, Treatment Outcome, Clinical Protocols, Preoperative Care, Protocol, Anti-Infective Agents, Local, Humans, Surgical Wound Infection, Surgery, Cardiac Surgical Procedures, Povidone-Iodine, cardiac surgery
Abstract: Introduction Surgical-site infection (SSI) is the second most frequent cause of healthcare-associated infection worldwide and is associated with increased morbidity, mortality and healthcare costs. Cardiac surgery is clean surgery with low incidence of SSI, ranging from 2% to 5%, but with potentially severe consequences. Perioperative skin antisepsis with an alcohol-based antiseptic solution is recommended to prevent SSI, but the superiority of chlorhexidine (CHG)–alcohol over povidone iodine (PVI)–alcohol, the two most common alcohol-based antiseptic solutions used worldwide, is controversial. We aim to evaluate whether 2% CHG–70% isopropanol is more effective than 5% PVI–69% ethanol in reducing the incidence of reoperation after cardiac surgery. Methods and analysis The CLEAN 2 study is a multicentre, open-label, randomised, controlled clinical trial of 4100 patients undergoing cardiac surgery. Patients will be randomised in 1:1 ratio to receive either 2% CHG–70% isopropanol or 5% PVI–69% ethanol for perioperative skin preparation. The primary endpoint is the proportion of patients undergoing any re-sternotomy between day 0 and day 90 after initial surgery and/or any reoperation on saphenous vein/radial artery surgical site between day 0 and day 30 after initial surgery. Data will be analysed on the intention-to-treat principle. Ethics and dissemination This protocol has been approved by an independent ethics committee 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 presentation at scientific conferences and publication in peer-reviewed journals. Trial registration number EudraCT 2017-005169-33 and NCT03560193.
Published: 2019
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6. Transvesical Intra-Abdominal Pressure Measurement in Newborn

Author: Anne Defontaine, Nathalie Costet, B. Ozanne, T. Gaillot, Olivier Tirel, Eric Wodey, Alexis Pierre Arnaud, Alain Beuchée, Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service de réanimation chirurgicale, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes (UR)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Male, Critical Illness, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Urinary Bladder, Population, Sodium Chloride, Critical Care and Intensive Care Medicine, Hypertension risk, 03 medical and health sciences, 0302 clinical medicine, Reference Values, Intensive Care Units, Neonatal, Abdomen, Pressure, Humans, Medicine, Prospective Studies, 030212 general & internal medicine, education, Saline, Intra abdominal pressure, education.field_of_study, Urinary bladder, business.industry, Critically ill, Infant, Newborn, 030208 emergency & critical care medicine, Administration, Intravesical, medicine.anatomical_structure, Volume (thermodynamics), Anesthesia, Pediatrics, Perinatology and Child Health, Female, business
Abstract: International audience; OBJECTIVE: To determine the optimal saline volume bladder instillation to measure intravesical pressure in critically ill newborns weighing less than 4.5 kg, and to establish a reference of intra-abdominal pressure value in this population. DESIGN: Prospective monocentric study. SETTING: Neonatal and PICU. PATIENTS: Newborns, premature or not, weighing less than 4.5 kg who required a urethral catheter. MEASUREMENTS AND MAIN RESULTS: Patients were classified into two groups according to whether they presented a risk factor for intra-abdominal hypertension. Nine intravesical pressure measures per patient were performed after different volume saline instillation. The first one was done without saline instillation and then by increments of 0.5 mL/kg to a maximum of 4 mL/kg. Linear models for repeated measurements of intravesical pressure with unstructured covariance were used to analyze the variation of intravesical pressure measures according to the conditions of measurement (volume instilled). Pairwise comparisons of intravesical pressure adjusted mean values between instillation volumes were done using Tukey tests, corrected for multiple testing to determine an optimal instillation volume. Forty-seven patients with completed measures (nine instillations volumes) were included in the analysis. Mean intravesical pressure values were not significantly different when measured after instillation of 0.5, 1, or 1.5 mL/kg, whereas measures after instillation of 2 mL/kg or more were significantly higher. The median intravesical pressure value in the group without intra-abdominal hypertension risk factor after instillation of 1 mL/kg was 5 mm Hg (2-6 mm Hg). CONCLUSIONS: The optimal saline volume bladder instillation to measure intra-abdominal pressure in newborns weighing less than 4.5 kg was 1 mL/kg. Reference intra-abdominal pressure in this population was found to be 5 mm Hg (2-6 mm Hg)
Published: 2016
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7. Population pharmacokinetics of daptomycin in critically ill patients with various degrees of renal impairment

Author: Philippe Seguin, Karim Asehnoune, Mickael Vourc'h, Sigismond Lasocki, Sandrine Marchand, Olivier Mimoz, Mathilde Barbaz, Martine Ferrandière, William Couet, Nicolas Grégoire, Yoann Launey, Thomas Gaillard, Pharmacologie des anti-infectieux (PHAR), 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, Service de Toxicologie - Pharmacocinétique [Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), Anesthésie-Réanimation 2 [CHRU Tours] (Hôpital Trousseau), Hôpital Trousseau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Pôle d'Anesthésie Réanimation, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Service d'anesthésie et réanimation chirurgicale [Nantes], Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Service d'anesthésie-réanimation [Hôtel-Dieu], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Hôtel-Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'anesthésie réanimation [Poitiers], Hôpital Trousseau (Tours)-Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Service d'anesthésie réanimation chirurgicale, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Hôtel-Dieu [Paris], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), and Université de Rennes (UR)-Hôpital Pontchaillou
Subjects: Male, 0301 basic medicine, health care facilities, manpower, and services, [SDV]Life Sciences [q-bio], Urine, urologic and male genital diseases, law.invention, MESH: Urine, MESH: Daptomycin, Plasma, MESH: Aged, 80 and over, law, MESH: Renal Insufficiency, Pharmacology (medical), Renal Insufficiency, Aged, 80 and over, MESH: Aged, MESH: Microbial Sensitivity Tests, MESH: Middle Aged, Middle Aged, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, Intensive care unit, Anti-Bacterial Agents, 3. Good health, Infectious Diseases, MESH: Young Adult, Toxicity, MESH: Critical Illness, Female, medicine.drug, Adult, Microbiology (medical), medicine.medical_specialty, Adolescent, Critical Illness, 030106 microbiology, Urology, Renal function, Microbial Sensitivity Tests, Biostatistics, MESH: Biostatistics, Young Adult, 03 medical and health sciences, Cmin, Daptomycin, Pharmacokinetics, MESH: Anti-Bacterial Agents, medicine, Humans, Adverse effect, MESH: Plasma, Aged, Pharmacology, MESH: Adolescent, MESH: Humans, business.industry, MESH: Adult, bacterial infections and mycoses, MESH: Male, Pharmacodynamics, business, MESH: Female
Abstract: The objective of this study was to characterize the pharmacokinetics of unbound and total concentrations of daptomycin in infected ICU patients with various degrees of renal impairment. From these results, the probability of attaining antimicrobial efficacy and the risks of toxicity were assessed.Twenty-four ICU patients with various renal functions and requiring treatment of complicated skin and soft-tissue infections, bacteraemia, or endocarditis with daptomycin were recruited. Daptomycin (Cubicin®) at 10 mg/kg was administered every 24 h for patients with creatinine clearance (CLCR) ≥30 mL/min and every 48 h for patients with CLCR30 mL/min. Total and unbound plasma concentrations and urine concentrations of daptomycin were analysed simultaneously following a population pharmacokinetic approach. Simulations were conducted to estimate the probability of attaining efficacy (unbound AUCu/MIC40 or80) or toxicity (Cmin24.3 mg/L) targets.Exposure to unbound daptomycin increased when the renal function decreased, thus increasing the probability of reaching the efficacy targets, but also the risk of toxicity. Modifications of the unbound fraction (fu) of daptomycin did not affect the pharmacokinetics of unbound daptomycin, but did affect the pharmacokinetics of total daptomycin.Daptomycin at 10 mg/kg q24h allowed efficacy pharmacokinetic/pharmacodynamic targets for ICU patients with CLCR ≥30 mL/min to be reached. For patients with CLCR30 mL/min, halving the rate of drug administration, i.e. 10 mg/kg q48h, was sufficient to reach these targets. No adverse events were observed, but the toxicity of the 10 mg/kg q24h dosing regimen should be further assessed, particularly for patients with altered renal function.
Published: 2018
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8. Characterizations of Pb(Zr 0.52 Ti 0.48 )O 3 thin film processed for sensor and actuator applications

Author: Brixi Nigassa, M, Soulimane, S., Orlianges, Jean-Christophe, Guines, Cyril, Rougier, Sébastien, marc, fabert, Launey, Y., Parou, Nicolas, Blondy, Pierre, Pothier, Arnaud, Université de Tlemcen, RF-ELITE : RF-Electronique Imprimée pour les Télécommunications et l'Energie (XLIM-RFEI), XLIM (XLIM), Université de Limoges (UNILIM)-Centre National de la Recherche Scientifique (CNRS)-Université de Limoges (UNILIM)-Centre National de la Recherche Scientifique (CNRS), Université de Limoges (UNILIM)-Centre National de la Recherche Scientifique (CNRS), Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou
Subjects: [SPI.NANO]Engineering Sciences [physics]/Micro and nanotechnologies/Microelectronics, ComputingMilieux_MISCELLANEOUS, [SPI.MAT]Engineering Sciences [physics]/Materials
Abstract: International audience
Published: 2018

9. Should we fear tubing adsorption of antibacterial drugs in extracorporeal membrane oxygenation? An answer for cephalosporins and carbapenems

Author: Cyril Leven, Eric Bellissant, Camille Tron, Marie-Clémence Verdier, Erwan Flecher, Pierre Tattevin, Florian Lemaitre, Nicolas Nesseler, Nicolas Maillard, Pierre Fillâtre, CHU Pontchaillou [Rennes], Department of clinical and biological pharmacology and pharmacovigilance, Laboratory of experimental and clinical pharmacology, Université de Rennes (UR), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CIC-IT Rennes, Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], Jonchère, Laurent, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Pontchaillou-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: medicine.medical_specialty, Physiology, medicine.drug_class, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Antibiotics, Cephalosporin, 030226 pharmacology & pharmacy, antibiotics, law.invention, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, Pharmacokinetics, law, Physiology (medical), Intensive care, medicine, Extracorporeal membrane oxygenation, Humans, Intensive care medicine, Pharmacology, business.industry, Extracorporeal circulation, Intensive Care, 030208 emergency & critical care medicine, Intensive care unit, Anti-Bacterial Agents, Cephalosporins, 3. Good health, [SDV] Life Sciences [q-bio], surgical procedures, operative, Carbapenems, Respiratory failure, [SDV.SP.PHARMA] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Adsorption, business, pharmacokinetics
Abstract: International audience; Extracorporeal membrane oxygenation (ECMO) procedure used in the management of patients with cardiac and/or respiratory failure could modify drugs pharmacokinetics (PK) properties. Studying the impact of ECMO devices on drugs PK is warranted to optimize dosage and ensure clinical outcomes. We aimed to characterize the behavior of four cephalosporins and three carbapenems commonly used in an ECMO circuit with an in-vitro approach focusing on the coated tubing, support of the extracorporeal circulation. Results suggest that these antibiotics are not sequestrated by ECMO tubing. This pilot mechanistic study provides original data that will contribute to improve our understanding of the impact of ECMO on the PK of drugs commonly used in intensive care unit patients.
Published: 2016
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10. Cerebrospinal fluid drainage and thoracic endovascular aneurysm repair

Author: Fabien Koskas, Michèle Bertrand, Pascal Colson, Marie-Hélène Fléron, Alain Cardon, Jean-Philippe Verhoye, Jean-Pierre Goarin, Edouard Kieffer, Gilles Godet, CHU Pontchaillou [Rennes], Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Institut de Chimie Radicalaire (ICR), Aix Marseille Université (AMU)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], Centre de Recherche des Cordeliers (CRC), Université Paris Diderot - Paris 7 (UPD7)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-Hôpital Pontchaillou, Université Pierre et Marie Curie - Paris 6 (UPMC)-École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie réanimation chirurgicale, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Service de chirurgie thoracique cardiaque et vasculaire [Rennes], Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Université Paris Diderot - Paris 7 (UPD7)-École pratique des hautes études (EPHE)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU), and Université Pierre et Marie Curie - Paris 6 (UPMC)-École pratique des hautes études (EPHE)
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Cerebrospinal Fluid Drainage, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Thoracoabdominal Aortic Aneurysms, Endovascular aneurysm repair, 03 medical and health sciences, Aortic aneurysm, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Risk Factors, medicine, Animals, Humans, Paraplegia, Aortic Aneurysm, Thoracic, business.industry, General Medicine, medicine.disease, Spinal cord, Blood vessel prosthesis implantation, Spinal cord ischemia, 3. Good health, Surgery, medicine.anatomical_structure, Treatment Outcome, 030228 respiratory system, Endovascular procedures, Anesthesia, cardiovascular system, Drainage, Cerebrospinal fluid pressure, Cardiology and Cardiovascular Medicine, business, Complication
Abstract: International audience; Spinal cord complications including paraplegia and partial neurologic deficits remain a frequent problem during repair of descending thoracic or thoracoabdominal aortic aneurysms. Effective prevention of this dreaded complication is of paramount importance. Among the many adjuncts that have been proposed to prevent spinal cord complications, spinal fluid drainage is one that has been used by numerous teams. The aim of this review is to answer the following question: does spinal fluid drainage afford spinal cord protection during both open and endovascular repair of thoracic or thoracoabdominal aortic aneurysms?
Published: 2017
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11. Management of Severe Bleeding in Patients Treated with Direct Oral Anticoagulants

Author: Dennis, Jessica, Medina-Rivera, Alejandra, Truong, Vinh, Antounians, Lina, Zwingerman, Nora, Carrasco, Giovana, Strug, Lisa, Wells, Phil, Trégouët, France, Morange, France, Wilson, Michael, Gagnon, France, Albaladejo, Pierre, Samama, Marc, Sié, Pierre, Kauffmann, Sophie, Mémier, Vincent, Suchon, Pierre, Viallon, Alain, David, Stéphane, Gruel, Yves, Bellamy, Lorenn, de Maistre, Emmanuel, Romegoux, Pauline, Thoret, Sophie, Pernod, Gilles, Bosson, Jean-Luc, Bazin, Etienne, Combaret, Nicolas, Cherprenet, Anne, Fares, Moustafa, Dufraisse, Sophie, Minville, Vincent, Morange, Pierre-Emmanuel, Leone, Marc, Cohen, William, Néant, Nadège, Marlu, Raphaël, Carpentier, Françoise, Defaye, Pascal, Mismetti, Patrick, Molliex, Serge, Lanoiselée, Julien, Piriou, Vincent, Delaleu-Rague, Carine, Lefèvre, Mathilde, Lagrange, Sophie, Ardillon, Lauren, Ozier, Yves, Bovet, Julien, Steib, Annick, Mebaouj, Sonia, Profumo, Louis, Roullet, Stéphanie, Smadja, David, Meyer, Guy, Journois, Didier, Trinh-Duc, Albert, Viard, Thibault, Belle, Loic, Levrat, Albrice, Gautheron, Etienne, Heluwaert, Frédéric, Schlumberger, Sylvie, Blanié, Antonia, Benhamou, Dan, Flaujac, Claire, Rosencher, Nadia, Beloeil, Hélène, Blery, Catherine, Daviet, Lauren, Guéret, Pierre, Faraoni, David, Schved, Jean François, Deras, Pauline, Jaber, Samir, Gueugniaud, Pierre Yves, Floccard, Bernard, Asehnoune, Karim, Paulus, Jerome, Amrani, Omar, Gonthier, Marie Caroline, Huisse, Marie Geneviève, Josserand, Julien, de Raucourt, Emmanuelle, Defournel, Cécile, Dubois, Yohann, Bouvier, Stéphane, Roy, Pierre-Marie, Lasocki, Sigismond, Carmagnac, Christian, Chastagner, Catherine, Thouret, Jean Marc, Sevestre, Marie Antoinette, Meaudre, Eric, Cungi, Pierre-Julien, Susen, Sophie, Lefrant, Jean Yves, Macey, Stéphane, Rieu, Jean Baptiste, Godier, Anne, University of Toronto, Program in genetics and genome biology, The Hospital for sick children [Toronto] (SickKids), Department of Molecular Genetics, Laboratorio Internacional de Investigación sobre el Genoma Humano, Universidad Nacional Autónoma de México = National Autonomous University of Mexico (UNAM), Division of Biostatistics, Dalla Lana School of Public Health, Ottawa Hospital Research Institute, ThEMAS, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Pôle Anesthésie Réanimation, CHU Grenoble-Hôpital Michallon-CHU Grenoble-Hôpital Michallon, Institut de médecine moléculaire de Rangueil (I2MR), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)- Institut Fédératif de Recherche Bio-médicale Institution (IFR150)-Institut National de la Santé et de la Recherche Médicale (INSERM), Nutrition, obésité et risque thrombotique (NORT), Institut National de la Recherche Agronomique (INRA)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Génétique, immunothérapie, chimie et cancer (GICC), UMR 7292 CNRS [2012-2017] (GICC UMR 7292 CNRS), Université de Tours (UT)-Centre National de la Recherche Scientifique (CNRS), Service d'Hématologie Clinique (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Techniques pour l'Evaluation et la Modélisation des Actions de la Santé (TIMC-IMAG-ThEMAS), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Pôle Anesthésie Réanimation [CHU de Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Biotechnologies, Pharmacologie Moléculaire et Cellulaire, Institut de Recherches Servier, Service des urgences, CHU Grenoble, Cardiac Stimulation and Rhythmology, Groupe de recherche sur la thrombose, pharmacologie des antithrombotiques et situations à risque (GRT), Université Jean Monnet - Saint-Étienne (UJM), Santé Ingénierie Biologie Saint-Etienne (SAINBIOSE), Centre Ingénierie et Santé (CIS-ENSMSE), École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hopital Cardiovasculaire, Hôpital Cardiologique de Lyon, Service de réanimation médicale polyvalente [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'Anesthésie-Réanimation (TP - SAR), CHU Strasbourg, Espace Ethiques et Politiques - Institut Hannah Arendt (EEP), Université Paris-Est Marne-la-Vallée (UPEM), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service d'Accueil des Urgences (AGEN - SAU), Centre Hospitalier d'Agen, Université de Bordeaux (UB), Service de Cardiologie (hôpital d'Annecy), Centre hospitalier de la région d'Annecy, Service d'hépato-gastroentérologie, Hôpital Cochin [AP-HP], Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, CHU Pontchaillou [Rennes], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service de réanimation chirurgicale, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), 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), Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Laboratoire SUBATECH Nantes (SUBATECH), Mines Nantes (Mines Nantes)-Université de Nantes (UN)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Centre National de la Recherche Scientifique (CNRS), Service des Urgences (PMR), CHRU - ANGERS, CHU d'Angers [Département Urgences], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Pôle de Pathologie cardiologie-vasculaire, Institut d'Hématologie-Transfusion-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Unité de soins intensifs, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Université Sorbonne Paris Cité (USPC), Universidad Nacional Autónoma de México (UNAM), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Pôle Anesthésie Réanimation, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR150-Institut National de la Santé et de la Recherche Médicale (INSERM), Aix Marseille Université (AMU)-Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Université de Tours-Centre National de la Recherche Scientifique (CNRS), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-IMAG-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Institut de Chimie de la Matière Condensée de Bordeaux (ICMCB), Centre National de la Recherche Scientifique (CNRS)-Université de Bordeaux (UB), Service d'Anesthésie-Réanimation, CHU Toulouse [Toulouse]-Institut Louis Bugnard-Hôpital de Rangueil, CHU Toulouse [Toulouse], INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Groupe de recherche sur la thrombose (GRT (EA 3065)), Université Jean Monnet [Saint-Étienne] (UJM), INSERM U1059, SAINBIOSE - Santé, Ingénierie, Biologie, Saint-Etienne (SAINBIOSE-ENSMSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), CHU Cochin [AP-HP], Service Anesthésie et Réanimation, Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Pôle Anesthésie Réanimation, Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Centre National de la Recherche Scientifique (CNRS)-Institut National de Physique Nucléaire et de Physique des Particules du CNRS (IN2P3)-Université de Nantes (UN)-Mines Nantes (Mines Nantes), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées- Institut Fédératif de Recherche Bio-médicale Institution (IFR150)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Toulouse [Toulouse]-Institut Louis Bugnard, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Ingénierie et Santé (CIS-ENSMSE), and Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)
Subjects: Rivaroxaban, business.industry, [SDV]Life Sciences [q-bio], Renal function, 030204 cardiovascular system & hematology, 3. Good health, Dabigatran, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, Anesthesia, Medicine, Apixaban, Observational study, In patient, 030212 general & internal medicine, business, Prospective cohort study, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug, Cohort study
Abstract: Background The use of prothrombin complex concentrates and the role of plasma concentration of anticoagulants in the management of bleeding in patients treated with direct oral anticoagulants are still debated. Our aim was to describe management strategies and outcomes of severe bleeding events in patients treated with direct oral anticoagulants. Methods We performed a prospective cohort study of 732 patients treated with dabigatran, rivaroxaban, or apixaban hospitalized for severe bleeding, included prospectively in the registry from June 2013 to November 2015. Results Bleeding was gastrointestinal or intracranial in 37% (212 of 732) and 24% (141 of 732) of the cases, respectively. Creatinine clearance was lower than 60 ml/min in 61% (449 of 732) of the cases. The plasma concentration of direct oral anticoagulants was determined in 62% (452 of 732) of the cases and was lower than 50 ng/ml or higher than 400 ng/ml in 9.2% (41 of 452) and in 6.6% (30 of 452) of the cases, respectively. Activated or nonactivated prothrombin complex concentrates were administered in 38% of the cases (281 of 732). Mortality by day 30 was 14% (95% CI, 11 to 16). Conclusions Management of severe bleeding in patients treated with direct oral anticoagulants appears to be complex. The use of prothrombin complex concentrates differs depending on bleeding sites and direct oral anticoagulant plasma concentrations. Mortality differs according to bleeding sites and was similar to previous estimates.
Published: 2017
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12. Ex Vivo Model to Decipher the Impact of Extracorporeal Membrane Oxygenation on Beta-lactam Degradation Kinetics

Author: Eric Bellissant, Marie-Clémence Verdier, Cyril Leven, Jérôme Laurent, Pierre Fillâtre, Pierre Tattevin, Florian Lemaitre, Antoine Petitcollin, Yoann Launey, N. Nesseler, Erwan Flecher, CHU Pontchaillou [Rennes], Department of clinical and biological pharmacology and pharmacovigilance, Laboratory of experimental and clinical pharmacology, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Service de Pharmacologie [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], Université de Rennes (UR), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-Hôpital Pontchaillou, and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: 0301 basic medicine, Cefotaxime, medicine.medical_treatment, Cefepime, 030106 microbiology, Ceftazidime, beta-Lactams, 03 medical and health sciences, 0302 clinical medicine, Extracorporeal Membrane Oxygenation, Pharmacokinetics, medicine, Extracorporeal membrane oxygenation, polycyclic compounds, Humans, Pharmacology (medical), Pharmacology, Volume of distribution, business.industry, 030208 emergency & critical care medicine, 3. Good health, Anti-Bacterial Agents, Kinetics, surgical procedures, operative, Anesthesia, Ceftriaxone, [SDV.IB]Life Sciences [q-bio]/Bioengineering, business, medicine.drug, Piperacillin
Abstract: International audience; BACKGROUND: As a consequence of drug sequestration, increase in volume of distribution, or alteration of elimination, extracorporeal membrane oxygenation (ECMO) might lead to inadequate plasma concentrations of vital drugs. The aim of this experimental study was to develop an ex vivo model to better characterize the impact of ECMO procedure on beta-lactam antibiotics pharmacokinetics. METHODS: Plasma concentrations of cefotaxime, ceftazidime, cefepime, piperacillin, oxacillin, amoxicillin, and ceftriaxone were measured in an ex vivo ECMO circuit primed with whole human blood and compared with controls stored in glass tubes and polyvinyl chloride tubing. Serial blood samples were collected over 48 hours, and the concentrations of beta-lactam antibiotics were quantified using a validated high-performance liquid chromatography assay. The concentrations' decay rate over time was compared between the ECMO circuits and controls using nonlinear mixed-effect modeling. RESULTS: Cefotaxime concentrations decreased markedly: 86% of the initial concentration remained after 4 hours and only 21% after 48 hours (P < 0.05 for the comparison in rate of decrease with both glass and polyvinyl chloride controls). There was no difference in the rate of decrease between ECMO circuit and controls for the other beta-lactam antibiotics. The average drug recoveries from the ECMO circuits at 48 hours were as follows: ceftazidime, 73%; cefepime, 67%; piperacillin, 71%; oxacillin, 46%; and amoxicillin, 72%. Concentrations of ceftriaxone remained stable throughout the 48-hour study both in ECMO circuits and in controls. CONCLUSIONS: Significant losses of cefotaxime were observed, whereas ceftazidime, cefepime, piperacillin, oxacillin, and amoxicillin decrease was moderate and similar to that of the control group, and ceftriaxone concentrations remained unchanged. These results are reassuring for the use of beta-lactam antibiotics in critically ill patients treated with ECMO.
Published: 2017
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13. Role of heparin in pulmonary cell populations in an in-vitro model of acute lung injury

Author: Marta Camprubí-Rimblas, Laura Chimenti, Antonio Artigas, Manuela Iglesias, Raquel Guillamat-Prats, Josep Bringué, Thomas Lebouvier, Lluis Blanch, Carme Obiols, Jessica Tijero, Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), This research was supported by CIBERES and Fundació Parc Taulí., Université de Rennes (UR)-Hôpital Pontchaillou, and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: Alveolar macrophages, Male, ARDS, medicine.drug_class, Acute Lung Injury, Inflammation, [SDV.CAN]Life Sciences [q-bio]/Cancer, 030204 cardiovascular system & hematology, Lung injury, Alveolar cells, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Diffuse alveolar damage, Cells, Cultured, Aged, lcsh:RC705-779, Lung, business.industry, Heparin, Research, Macrophages, Anticoagulant, Anticoagulants, 030208 emergency & critical care medicine, lcsh:Diseases of the respiratory system, alveolar macrophages, Middle Aged, Fibroblasts, [SDV.MHEP.EM]Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism, medicine.disease, 3. Good health, Pulmonary Alveoli, medicine.anatomical_structure, Treatment Outcome, Acute Respiratory Distress Syndrome (ARDS), Immunology, Cytokines, Female, medicine.symptom, Inflammation Mediators, business, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition, medicine.drug
Abstract: International audience; BACKGROUND: In the early stages of acute respiratory distress syndrome (ARDS), pro-inflammatory mediators inhibit natural anticoagulant factors and initiate an increase in procoagulant activity. Previous studies proved the beneficial effects of heparin in pulmonary coagulopathy, which derive from its anticoagulant and anti-inflammatory activities, although it is uncertain whether heparin works. Understanding the specific effect of unfractioned heparin on cell lung populations would be of interest to increase our knowledge about heparin pathways and to treat ARDS. METHODS: In the current study, the effect of heparin was assessed in primary human alveolar macrophages (hAM), alveolar type II cells (hATII), and fibroblasts (hF) that had been injured with LPS. RESULTS: Heparin did not produce any changes in the Smad/TGFß pathway, in any of the cell types evaluated. Heparin reduced the expression of pro-inflammatory markers (TNF-α and IL-6) in hAM and deactivated the NF-kß pathway in hATII, diminishing the expression of IRAK1 and MyD88 and their effectors, IL-6, MCP-1 and IL-8. CONCLUSIONS: The current study demonstrated that heparin significantly ameliorated the cells lung injury induced by LPS through the inhibition of pro-inflammatory cytokine expression in macrophages and the NF-kß pathway in alveolar cells. Our results suggested that a local pulmonary administration of heparin through nebulization may be able to reduce inflammation in the lung; however, further studies are needed to confirm this hypothesis.
Published: 2017
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14. Effectiveness and complications of ultrasound-guided subclavian vein cannulation in children and neonates

Author: François de la Brière, Claude Ecoffey, Anne Defontaine, Charlotte Engrand, Bruno Laviolle, Sabrina Dessard, Cécile Gauvrit, Nicolas Nardi, Severine Delahaye, Eric Wodey, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Pharmacologie [Rennes], CHU Pontchaillou [Rennes], Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Brenner, Nelly, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: Male, medicine.medical_specialty, Endpoint Determination, [SDV]Life Sciences [q-bio], Subclavian, Anesthesia, General, Critical Care and Intensive Care Medicine, Subclavian Vein, Catheterization, Central venous, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Catheterization, Peripheral, medicine, Humans, General anaesthesia, Prospective Studies, Treatment Failure, Child, Children, Ultrasonography, Interventional, Ultrasonography, Catheter insertion, business.industry, Incidence (epidemiology), Infant, Newborn, Infant, 030208 emergency & critical care medicine, General Medicine, Arteries, medicine.disease, 3. Good health, Surgery, [SDV] Life Sciences [q-bio], Anesthesiology and Pain Medicine, Pneumothorax, Brachiocephalic, Anesthesia, Child, Preschool, Cohort, Observational study, Female, Complication, business, Subclavian vein
Abstract: International audience; Background The ultrasound (US)-guided supraclavicular approach to subclavian vein (Sup-SCV) catheterisation in children has recently been described and evaluated in a small cohort. The aim of this study was to assess this technique in a large paediatric cohort including neonates. Methods We conducted a prospective observational study between November 2010 and December 2013 which included 615 children divided into two groups according to their weight: Group 1 ≤ 5 kg (n = 124), Group 2 > 5 kg (n = 491). All procedures were performed under general anaesthesia by an anaesthesiologist or a supervised resident. The success rates of catheter insertion, the number of punctures required, the procedure time, and the complication rates were analysed. Results Sup-SCV catheterisation was successful in 98% of the cases and was higher in Group 2 than in Group 1 (99.4% versus 92.7%, P
Published: 2016
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15. Reply: The Impact of Septic Liver Dysfunction on Long-Term Mortality Must Not Be Neglected

Author: Nicolas Nesseler, Jennifer White, Philippe Seguin, Caroline Aninat, Anne Corlu, Karen S. Pieper, Yannick Mallédant, Yoann Launey, Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Pontchaillou [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, Liver Diseases, [SDV]Life Sciences [q-bio], 030208 emergency & critical care medicine, Critical Care and Intensive Care Medicine, Shock, Septic, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Humans, Medicine, Long term mortality, Liver dysfunction, business, Intensive care medicine, ComputingMilieux_MISCELLANEOUS
Abstract: International audience; no abstract
Published: 2016
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16. The Accuracy of Temperature Measurements Provided by the Edwards Lifesciences Pulmonary Artery Catheter

Author: Raphaëlle Larmet, Nicolas Nesseler, Yannick Mallédant, Philippe Seguin, Yoann Launey, Clément Palpacuer, Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Pontchaillou [Rennes], Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes (UR)-Hôpital Pontchaillou, and Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Time Factors, endocrine system diseases, Thermometers, Critical Illness, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Thermodilution, education, 030204 cardiovascular system & hematology, Temperature measurement, 03 medical and health sciences, Catheters, Indwelling, 0302 clinical medicine, Predictive Value of Tests, Materials Testing, Calibration, Humans, Medicine, 030212 general & internal medicine, Resistance thermometer, Monitoring, Physiologic, business.industry, Critically ill, Pulmonary artery catheter, Reproducibility of Results, food and beverages, Equipment Design, Reference Standards, Confidence interval, 3. Good health, Intensive Care Units, Catheter, Anesthesiology and Pain Medicine, Catheterization, Swan-Ganz, Predictive value of tests, business, Nuclear medicine, Vascular Access Devices, Body Temperature Regulation
Abstract: International audience; BACKGROUND: Pulmonary artery catheters (PACs) are frequently used for monitoring patient temperatures in the intensive care unit. Nevertheless, data regarding the accuracy of these measurements are lacking, and few data testify to the accuracy of temperatures recorded after the PAC has been in place for several days. The absolute values of such measurements are relevant for critical care because patient temperatures are often used as diagnostic criteria for sepsis and antibiotic therapy. We thus hypothesized that the Edwards Lifesciences PAC would accurately measure blood temperature. To test our hypothesis, we compared temperature measurements obtained from PACs inserted in patients for different lengths of time with measurements of a reference platinum resistance thermometer (PRT). METHODS: PACs were removed and analyzed in 39 patients in whom PACs were inserted for 0 to 5 days. The PACs were placed in calibration baths, and 10 consecutive measurements at each of 7 different temperatures were obtained (36°C, 36.5°C, 37°C, 38°C, 38.3°C, 39°C, and 40°C). The temperature measurements obtained using PACs were compared with measurements obtained using a PRT. Bland-Altman statistical analyses were performed. Outliers, defined as PAC temperature measurements that varied more than ±0.3°C from PRT measurements, were identified. We considered a catheter unfit for clinical diagnostic or therapeutic use if ≥15% of data pairs were outliers. RESULTS: A total of 2730 data pairs were analyzed. Overall, the bias was -0.15°C; the precision was +0.13°C; and the limits of agreement were -0.45°C to +0.13°C. The bias and limits of agreement did not differ according to the age of the catheter or the temperature tested. One hundred fourteen data pairs (4.2% [95% confidence interval, 2.0%-6.4%]), involving 13 PACs and mostly from 4 PACs, were outliers. CONCLUSIONS: We conclude that temperature measurements obtained using the Edwards Lifesciences PACs are thus sufficiently accurate to be used for clinical temperature monitoring in critically ill patients
Published: 2016
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17. Liver Dysfunction Is Associated with Long-Term Mortality in Septic Shock

Author: Caroline Aninat, Yannick Mallédant, Anne Corlu, Yoann Launey, Karen S. Pieper, Jennifer White, Nicolas Nesseler, Philippe Seguin, Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Pontchaillou [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, Septic shock, [SDV]Life Sciences [q-bio], 030208 emergency & critical care medicine, Critical Care and Intensive Care Medicine, medicine.disease, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, medicine, Long term mortality, Liver dysfunction, Intensive care medicine, business, ComputingMilieux_MISCELLANEOUS
Abstract: International audience; To the Editor
Published: 2016
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18. Safety of recombinant factor VIIa in patients under extracorporeal membrane oxygenation

Author: Marie Aymami, Solène Granry, Yannick Mallédant, Erwan Flecher, Vito G. Ruggieri, Yves Le Tulzo, Jean-Philippe Verhoye, Patrick Guinet, Pierre Gueret, Amedeo Anselmi, Bernard Lelong, Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Foie, métabolismes et cancer, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-Hôpital Pontchaillou, and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: Male, Databases, Factual, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Tertiary Care Centers, chemistry.chemical_compound, 0302 clinical medicine, Hospital Mortality, Heart transplantation, biology, Factor VII, Extracorporeal membrane oxygenation, General Medicine, Middle Aged, Recombinant Proteins, 3. Good health, Cardiac surgery, Treatment Outcome, surgical procedures, operative, Cardiothoracic surgery, Anesthesia, Female, Patient Safety, Cardiology and Cardiovascular Medicine, Adult, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Hemorrhage, Factor VIIa, Outcomes, Risk Assessment, 03 medical and health sciences, Thromboembolism, Intensive care, medicine, Humans, Cardiac Surgical Procedures, Survival rate, Aged, Retrospective Studies, Heart Failure, business.industry, Bleeding, Survival Analysis, Surgery, 030228 respiratory system, chemistry, Recombinant factor VIIa, Case-Control Studies, biology.protein, business, Follow-Up Studies
Abstract: International audience; OBJECTIVES: To address the safety (rate of thromboembolic events and circuit complications) and efficacy (rate of bleeding control) of recombinant activated coagulation factor VII (rFVIIa) to treat severe bleeding refractory to all surgical and medical treatments in patients under veno-arterial (VA) or veno-venous (VV) extracorporeal membrane oxygenation (ECMO) support. METHODS: In a tertiary referral University Cardiothoracic Surgery Centre including three intensive care units, 30 patients received the rFVIIa during ongoing VA or VV ECMO support (8.6% of ECMO activity from 2005 to 2014; N = 347). Early and late clinical results were analysed (retrospective analysis of prospectively collected data). In a substudy, a case-matching procedure was performed among ECMO patients who received (Group A) or did not receive (Group B) rFVIIa treatment. RESULTS: The mediastinum was the most common site of refractory bleeding (after heart transplantation or other cardiac surgery; 90%); 90% (n = 27) of patients were on VA ECMO and the remainder on VV ECMO. The survival rate at ECMO explantation and at the 30th post-implantation day was 67 and 50%, respectively. The final efficacy rate of rFVIIa in stopping bleeding was 93.3%. The rate of thromboembolic events was 3.3% (1 case) and the rate of circuit change was 16.7% (without instances of overt circuit clotting). After case-matching, Group A comprised 23 patients and Group B included 43 patients. No statistically significant differences were observed among groups in terms of thromboembolic events (P = 0.99), circuit change, ventilation time (P = 0.71), infectious complications (P = 06) and survival at both ECMO explantation and the 30th post-implantation day. Late survival was comparable (Kaplan-Meier analysis; P = 0.42). CONCLUSIONS: In case of life-threatening bleeding refractory to all conventional therapies, rFVIIa presents an acceptable safety profile in patients under ECMO support. No circuit dysfunctions and limited rates of thromboembolism are observed.
Published: 2016
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19. Tolerance and efficacy of a polyamine-deficient diet for the treatment of perioperative pain

Author: Anissa Belbachir, Anne-Laure Sérandour, Pierre Schoeffler, Florin Dimache, Georges Daccache, Jean-Pierre Estebe, Cécile Degryse, Alain Le Naoures, Gilles Rezzadori, Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, CHU Pontchaillou [Rennes], CHU de Bordeaux Pellegrin [Bordeaux], Hôpital Pasteur [Nice] (CHU), Hôpital de Hautepierre [Strasbourg], Département d'anesthésiologie [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Service de réanimation médicale polyvalente [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, SLB Pharma, Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'anesthésie réanimation chirurgicale, Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou, Hôpital Pasteur [Nice] ( CHU ), Département d'anesthésiologie [Caen], Université de Caen Normandie ( UNICAEN ), Normandie Université ( NU ) -Normandie Université ( NU ) -CHU Caen, CHU Cochin [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP), and CHU Gabriel Montpied ( CHU )
Subjects: Adult, Male, Analgesic effect, Endocrinology, Diabetes and Metabolism, [ SDV.AEN ] Life Sciences [q-bio]/Food and Nutrition, polyamines, Analgesic, perioperative pain, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, NMDA receptors, Perioperative Care, 03 medical and health sciences, chemistry.chemical_compound, spine surgery, 0302 clinical medicine, Quality of life, Surveys and Questionnaires, Humans, Medicine, In patient, pain, Prospective Studies, Brief Pain Inventory, [ SDV.MHEP.CHI ] Life Sciences [q-bio]/Human health and pathology/Surgery, Aged, Nutrition and Dietetics, Dose-Response Relationship, Drug, business.industry, Perioperative, Middle Aged, 3. Good health, Clinical trial, Treatment Outcome, chemistry, 030220 oncology & carcinogenesis, Anesthesia, Quality of Life, Patient Compliance, Female, Polyamine, business, diet, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition, 030217 neurology & neurosurgery
Abstract: Background Polyamines have been identified as pain agonists and interact with N-methyl-D-aspartate receptors. A prospective, randomized, multicenter, and blinded phase II clinical trial was conducted to evaluate a polyamine-deficient diet for the treatment of perioperative pain in patients during spinal surgery. Methods All analyses followed the intention-to-treat principle. The trial was designed to evaluate the dose-ranging effect of a low polyamine diet with respect to a total (group 1) or partial (group 2) polyamine diet on perioperative pain (7 d before and 5 d after surgery). Pain (numerical scale at rest and motion), quality of life questionnaires (Brief Pain Inventory, EIFEL questionnaire, and Short Form-12 acute questionnaire), and tolerance of and compliance with the nutritional program were measured. Results Compliance (preoperatively: 100% in group 1 and 83% in group 2; postoperatively: 83% in group 1 and 71% in group 2) and tolerance were good. After 7 d following the diet before surgery, decreased pain was observed in group 1 whereas no effect was observed in group 2 ( P = 0.144). This analgesic effect became significant in group 1 in the subgroup of patients with initial high levels of pain (NS ≥ 4) at rest ( P = 0.03) and during motion ( P = 0.011). Quality of life was significantly improved in group 1 ( P = 0.0465). In the postoperative period, pain was significantly decreased in group 1 compared to group 2 at rest ( P = 0.022) and during motion ( P = 0.029). The effect was significantly better on patients with higher initial pain both at rest ( P = 0.013) and during motion ( P = 0.005) in group 1 compared to group 2. Conclusion Suppression of polyamines from the diet offers a nutrition-based treatment option for perioperative pain reduction independent of and complementary to typical analgesic approaches.
Published: 2016
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20. Faut-il contrôler la fièvre dans les infections sévères ? [Is control fever mandatory in severe infections?]

Author: Seguin, Philippe, Launey, Y., Nesseler, N., Malledant, Yannick, Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Service d'Anesthésie Réanimation [Rennes], CHU Pontchaillou [Rennes], Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes (UR)-Hôpital Pontchaillou, and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, [SDV.CAN]Life Sciences [q-bio]/Cancer
Abstract: National audience; Temperature control during severe sepsis is currently used in intensive care and involves 66% and 70% of severe sepsis and septic shock, respectively. Nevertheless, the conclusive evidence of the benefit of such a strategy is still lacking.We might wonder, with regards to experimental works and recent noninterventional studies, about the risk of a control strategy on an ongoing infectious process, the patient’s outcome, and the safety of the means implemented to obtain temperature control. On the other hand, it is also demonstrated that fever increases oxygen consumption, which may lead in some clinical situations to tissular ischemia and that fever may be associated with a deleterious focal inflammatory process. Methods to control the temperature include external and/or internal cooling and/or antipyretic medications such as paracetamol and nonsteroidal antiinflammatory drugs. In septic patients, external cooling and paracetamol are the mains means used to control temperature. Despite the uncertainties about the benefit to control or not the temperature, it could be stated that extreme temperature (hypo- or hyperthermia) should be avoided and that the benefit/risk of temperature control must be individually weighted. © 2015, Société de réanimation de langue française (SRLF) and Springer-Verlag France.
Published: 2016
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21. Empiric antimicrobial therapy for ventilator-associated pneumonia after brain injury

Author: Sigismond Lasocki, Pierre Joachim Mahe, Lise Thioliere, Bertrand Rozec, Philippe Seguin, Fanny Feuillet, Ronan Le Floch, Raphaël Cinotti, Antoine Roquilly, Yoann Launey, Véronique Sébille, Yannick Mallédant, Tanguy Cazaubiel, Karim Asehnoune, Nicolas Nesseler, Didier Lepelletier, Service d'Anesthésie-Réanimation [CHU Limoges], CHU Limoges, 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), Biostatistique, Recherche Clinique et Mesures Subjectives en Santé, Université de Nantes (UN), Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Pontchaillou [Rennes], Pôle d'Anesthésie Réanimation, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Hôtel-Dieu de Nantes, Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Unité de recherche de l'institut du thorax (ITX-lab), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Service d’Anesthésie-Réanimation, Hôpital Guillaume et René Laennec-Centre hospitalier universitaire de Nantes (CHU Nantes), Biostatistique, Pharmacoépidémiologie et Mesures Subjectives en Santé, PRES Université Nantes Angers Le Mans (UNAM), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), and unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX)
Subjects: Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Time Factors, [SDV]Life Sciences [q-bio], Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Intensive care, Internal medicine, Drug Resistance, Bacterial, Severity of illness, medicine, Humans, Glasgow Coma Scale, Prospective Studies, 030212 general & internal medicine, Intensive care medicine, Prospective cohort study, business.industry, Incidence, Ventilator-associated pneumonia, Pneumonia, Ventilator-Associated, 030208 emergency & critical care medicine, Middle Aged, Antimicrobial, medicine.disease, Anti-Bacterial Agents, 3. Good health, Intensive Care Units, Pneumonia, Area Under Curve, Brain Injuries, Multivariate Analysis, Cohort, Female, Burns, business, Empiric therapy
Abstract: Issues regarding recommendations on empiric antimicrobial therapy for ventilator-associated pneumonia (VAP) have emerged in specific populations.To develop and validate a score to guide empiric therapy in brain-injured patients with VAP, we prospectively followed a cohort of 379 brain-injured patients in five intensive care units. The score was externally validated in an independent cohort of 252 brain-injured patients and its extrapolation was tested in 221 burn patients.The multivariate analysis for predicting resistance (incidence 16.4%) showed two independent factors: preceding antimicrobial therapy ≥48 h (pLimited-spectrum empirical antimicrobial therapy has low risk of failure in brain-injured patients presenting with VAP before day 10 and when prior antimicrobial therapy lasts
Published: 2016
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22. Dramatic vascular compression by tension pneumoperitoneum

Author: Yannick Mallédant, Yoann Launey, Philippe Seguin, Kathleen Turner, Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Pontchaillou [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: Adult, Male, medicine.medical_specialty, Abdominal pain, Vascular compression, Pain medicine, health care facilities, manpower, and services, education, Vena Cava, Inferior, [SDV.CAN]Life Sciences [q-bio]/Cancer, Constriction, Pathologic, Critical Care and Intensive Care Medicine, Iliac Artery, 03 medical and health sciences, 0302 clinical medicine, Pneumoperitoneum, Anesthesiology, medicine, Humans, Aorta, Abdominal, Vascular Diseases, health care economics and organizations, Iliac artery, Portal Vein, Tension (physics), business.industry, 030208 emergency & critical care medicine, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, medicine.disease, digestive system diseases, Abdominal Pain, 3. Good health, Surgery, Tomography x ray computed, 030228 respiratory system, medicine.symptom, Tomography, X-Ray Computed, business
Abstract: International audience; A 40-year-old man with a history of Crohn’s disease had undergone screening colonoscopy...
Published: 2016
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23. Cerebral Microdialysis Effects of Propofol versus Midazolam in Severe Traumatic Brain Injury

Author: M. Tanguy, Yannick Mallédant, Bruno Laviolle, Philippe Seguin, Jean-Paul Bleichner, Xavier Morandi, Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Pharmacologie du Sepsis et Choc Septique, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)-Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Service de Pharmacologie [Rennes], CHU Pontchaillou [Rennes]-CHU Pontchaillou [Rennes]-Service de réanimation chirurgicale, Université de Rennes (UR)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service de neurochirurgie [Rennes] = Neurosurgery [Rennes], CHU Pontchaillou [Rennes], Le Corre, Morgane, Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)-Foie, métabolismes et cancer, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Service de Pharmacologie [Rennes], and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes]
Subjects: Glycerol, Male, Microdialysis, medicine.medical_treatment, 0302 clinical medicine, MESH: Hypnotics and Sedatives, Pyruvic Acid, Hypnotics and Sedatives, Single-Blind Method, MESH: Microdialysis, MESH: Brain Chemistry, 030212 general & internal medicine, Propofol, Cerebral Cortex, Glutamate receptor, MESH: Neuroprotective Agents, MESH: Glutamic Acid, 3. Good health, MESH: Glucose, Neuroprotective Agents, MESH: Propofol, Anesthesia, Female, medicine.symptom, medicine.drug, Adult, Traumatic brain injury, Midazolam, Sedation, Glutamic Acid, Neuroprotection, 03 medical and health sciences, MESH: Glycerol, medicine, Humans, Lactic Acid, MESH: Pyruvic Acid, Brain Chemistry, MESH: Humans, business.industry, Vitamin E, MESH: Biological Markers, MESH: Adult, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, MESH: Single-Blind Method, medicine.disease, MESH: Male, MESH: Cerebral Cortex, [SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Glucose, Brain Injuries, MESH: Midazolam, MESH: Brain Injuries, MESH: Lactic Acid, Neurology (clinical), business, MESH: Female, Biomarkers, 030217 neurology & neurosurgery
Abstract: International audience; Propofol, an anesthetic agent acting as an analogue of vitamin E, has been advocated to be an ideal neuroprotective agent both in animal models and in clinical practice, due to its positive effects on oxidative stress. Nevertheless, no studies have compared this agent to another sedative agent used for sedation after traumatic brain injury (TBI). The objective was to compare the effects of propofol to midazolam on cerebral biomarkers at the acute phase of severe TBI patients. Thirty patients aged 35±18 years were prospectively randomized to receive propofol or midazolam and 29 were analyzed (n=15 for propofol, and n=14 for midazolam). A cerebral microdialysis catheter was used to measure the lactate:pyruvate (L:P) ratio, glutamate, glycerol, and glucose for 72 h. No difference between groups was observed for the L:P ratio (time effect p=0.201, treatment effect p=0.401, time×treatment interaction p=0.101). Similarly, no difference was observed for glutamate (time effect p=0.930, treatment effect p=0.651, time×treatment interaction p=0.353), glycerol (time effect p=0.223, treatment effect p=0.922, time×treatment interaction p=0.308), or glucose (time effect p=0.116, treatment effect p=0.088, time×treatment interaction p=0.235). These results do not support a difference between propofol and midazolam for sedation for the cerebral metabolic profile in severe TBI.
Published: 2012
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24. Electrocardiographic and Hemodynamic Effects of Intravenous Infusion of Bupivacaine, Ropivacaine, Levobupivacaine, and Lidocaine In Anesthetized Ewes

Author: David Bec, Jean-Yves Bansard, Patrick Guinet, Pascal Lecorre, Eric Wodey, Jean-Pierre Estebe, Maja Ratajczak-Enselme, François Chevanne, Claude Ecoffey, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Laboratoire de Pharmacie Galenique, Biopharmacie et Pharmacie Clinique, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Senhadji, Lotfi, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-Hôpital Pontchaillou, Laboratoire de Pharmacie Galenique, Biopharmacie et Pharmacie Clinique [Rennes], and Université de Rennes (UR)
Subjects: Tachycardia, Time Factors, Lidocaine, MESH: Myocardial Contraction, Blood Pressure, Ventricular tachycardia, Electrocardiography, 0302 clinical medicine, [INFO.INFO-TS]Computer Science [cs]/Signal and Image Processing, Heart Rate, 030202 anesthesiology, Cluster Analysis, Ropivacaine, MESH: Animals, Anesthetics, Local, MESH: Heart Rate, Infusions, Intravenous, Levobupivacaine, Principal Component Analysis, MESH: Anesthesia, General, MESH: Blood Pressure, General Medicine, Bupivacaine, MESH: Amides, 3. Good health, [SDV.SP.PHARMA] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Anesthesia, MESH: Bupivacaine, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, medicine.symptom, [SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing, medicine.drug, MESH: Hemodynamics, [INFO.INFO-TS] Computer Science [cs]/Signal and Image Processing, MESH: Sheep, Anesthesia, General, MESH: Anesthetics, Local, QT interval, 03 medical and health sciences, QRS complex, medicine, Animals, cardiovascular diseases, MESH: Infusions, Intravenous, [SPI.SIGNAL] Engineering Sciences [physics]/Signal and Image processing, [SDV.IB] Life Sciences [q-bio]/Bioengineering, MESH: Principal Component Analysis, Models, Statistical, Sheep, business.industry, MESH: Time Factors, Hemodynamics, medicine.disease, Amides, Myocardial Contraction, MESH: Cluster Analysis, MESH: Electrocardiography, MESH: Lidocaine, Anesthesiology and Pain Medicine, Tachycardia, Ventricular, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, MESH: Tachycardia, Ventricular, business, MESH: Female, MESH: Models, Statistical, 030217 neurology & neurosurgery
Abstract: International audience; BACKGROUND AND OBJECTIVES: Neural blockade techniques are associated with a risk of acute cardiac toxicity after accidental intravenous (IV) injection of local anesthetics. The aim of this study was to compare electrocardiographic (ECG) and hemodynamic (HEM) effects induced by IV infusion of local anesthetics in an anesthetized ewe model. METHODS: Thirty-two anesthetized ewes received IV bupivacaine (BUPI), ropivacaine (ROPI), or levobupivacaine (S-BUPI) at an equimolar dose, or lidocaine (LIDO) at a 3-fold higher rate (n = 8 in each group). RR, PR, QRS, and QT intervals (QTc), changes (Delta) in systolic and diastolic arterial pressure (SAP and DAP), and in myocardial contractility (dP/dt), were assessed every 30 seconds for 7 minutes. From main ECG variables (RR, PR, QRS, QT), we proposed to use multiple correspondence analysis and hierarchical ascending classification to explore the structure of statistical dependencies among those measurements, and to determine the different patterns of ECG and HEM changes induced by infusion of BUPI, ROPI, S-BUPI, and LIDO. RESULTS: Graphic representation of multiple correspondence analysis associated BUPI with the most pronounced modifications in ECG and HEM variables, followed by in decreasing order ROPI, S-BUPI, and LIDO. Comparisons of clusters identified by hierarchical ascending classification confirmed this classification for ECG variables. Ventricular tachycardia occurred only in the BUPI group. CONCLUSIONS: In our anesthetized ewe model, high dose IV infusion of BUPI induced the most marked changes in RR, PR, QRS, QT, QTc intervals, DeltaSAP, and DeltadP/dt. ROPI altered ECG variables less than BUPI but more than S-BUPI. LIDO was associated with the smallest changes.
Published: 2009
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25. Variation of bispectral index under TIVA with propofol in a paediatric population

Author: Jean-Yves Bansard, Claude Ecoffey, E. Wodey, Lotfi Senhadji, Olivier Tirel, Rupert Harris, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Department of Anaesthesia, St George's Hospital, Senhadji, Lotfi, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Rennes (UR)-Hôpital Pontchaillou
Subjects: Aging, paediatric, depth, Blood Pressure, 0302 clinical medicine, Bolus (medicine), [INFO.INFO-TS]Computer Science [cs]/Signal and Image Processing, Heart Rate, 030202 anesthesiology, Prospective Studies, Child, i.v, Electroencephalography, anaesthesia, anaesthetics, Child, Preschool, [SDV.SP.PHARMA] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Anesthesia, Bispectral index, Plasma concentration, pharmacokinetic model, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Propofol, [SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing, Anesthetics, Intravenous, remifentanil, medicine.drug, Adolescent, [INFO.INFO-TS] Computer Science [cs]/Signal and Image Processing, plasma concentration, Remifentanil, Drug Administration Schedule, Article, 03 medical and health sciences, [SDV.MHEP.PED] Life Sciences [q-bio]/Human health and pathology/Pediatrics, Pharmacokinetics, Monitoring, Intraoperative, Heart rate, bispectral index, medicine, Humans, [SPI.SIGNAL] Engineering Sciences [physics]/Signal and Image processing, [SDV.IB] Life Sciences [q-bio]/Bioengineering, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, Dose-Response Relationship, Drug, propofol, business.industry, 030208 emergency & critical care medicine, bispectrum, monitoring, Anesthesiology and Pain Medicine, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, business, Paediatric population
Abstract: International audience; BACKGROUND: In this prospective observational study, we aim to explore the relationship between age and bispectral index (BIS) values at different plasma concentrations of propofol. METHODS: Fifty children aged from 3 to 15 yr were included. Anaesthesia was induced using a target-controlled infusion of propofol with the Kataria pharmacokinetic model together with a bolus of remifentanil followed by a continuous infusion rate at 0.2 microg kg(-1) min(-1). Target plasma propofol concentration was initially stabilized to 6 microg ml(-1) and continued for 6 min. The target was then decreased and stabilized to 4 microg ml(-1) and then to 2 microg ml(-1). BIS values, plasma propofol concentration, and EEG were continuously recorded. In order to explore the relationship between variations in propofol concentration and the EEG bispectrum, we used a multiple correspondence analysis (MCA). Results are shown in median (range). RESULTS: We found no statistical difference between BIS values with propofol 6 microg ml(-1) [23 (12-40)] and 4 microg ml(-1) [28 (9-67)]. At 2 microg ml(-1), BIS was significantly different [52 (24-71)], but a significant correlation between the age of children and BIS values was found (r2=0.66; P
Published: 2008
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26. Assessment of noninvasive acoustic respiration rate monitoring in patients admitted to an Emergency Department for drug or alcoholic poisoning

Author: Ratajczak-Enselme, Maja, Grégoire, Nicolas, Estebe, Jean-Pierre, Dollo, Gilles, Chevanne, F., Bec, David, Ecoffey, Claude, Couet, William, Le Corre, Pascal, Guechi, Youcef, Pichot, Amélie, Frasca, Denis, Rayeh-Pelardy, Fatima, Lardeur, Jean-Yves, Mimoz, Olivier, Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Laboratoire de Pharmacie Galenique, Biopharmacie et Pharmacie Clinique, Université de Rennes 1 (UR1), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Université de Rennes 1 - Faculté des sciences pharmaceutiques et biologiques (UR1 Pharmacie), Service d'anesthésie réanimation [Poitiers], Service des maladies infectieuses et réanimation médicale, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Service d'anesthésie réanimation chirurgicale, Centre Hospitalo-Universitaire de Rennes, Pôle Pharmacie, Université de Rennes (UR)-Hôpital Pontchaillou, Laboratoire de Pharmacie Galenique, Biopharmacie et Pharmacie Clinique [Rennes], Université de Rennes (UR), and Université de Rennes - Faculté des sciences pharmaceutiques et biologiques (UR Pharmacie)
Subjects: Adult, Male, Substance-Related Disorders, [SDV]Life Sciences [q-bio], Poison control, Health Informatics, Critical Care and Intensive Care Medicine, Cardiography, Impedance, 03 medical and health sciences, 0302 clinical medicine, Respiratory Rate, Capnography, 030202 anesthesiology, Thoracic impedance, Humans, Medicine, In patient, Contraindication, ComputingMilieux_MISCELLANEOUS, Monitoring, Physiologic, Ethanol, business.industry, Poisoning, Limits of agreement, Acoustic sensor, 030208 emergency & critical care medicine, Acoustics, Emergency department, Middle Aged, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, 3. Good health, Anesthesiology and Pain Medicine, Anesthesia, Female, Emergency Service, Hospital, business, Respiration rate
Abstract: To compare respiration rate measurement by an acoustic method and thoracic impedance to capnometry as the reference method, in patients at the Emergency Department after drug or alcoholic poisoning. In this observational study, 30 patients aged 18 or older, hospitalized at the Emergency Department for drug or alcoholic poisoning, without any contraindication to a face mask and/or a cervical acoustic sensor, were included in the study. They benefited from a simultaneous recording of their respiration rate by the acoustic method (RRa(®), Masimo Corp., Irvine, CA, USA), by thoracic impedance (Philips Intellivue(®) MP2, Suresnes, France) and by capnometry (Capnostream(®) 20, Oridion, Jerusalem, Israel) through a face mask (Capnomask(®), Mediplus Ltd, Raleigh, NC, USA) for 40-60 min. Of the 86,578 triplets collected, 77,155 (89.1%) were exploitable. Median (range) respiration rate measured by capnometry was 18 (7-29) bpm. Compared to capnometry, bias and limits of agreement were 0.1 ± 3.8 bpm for the acoustic method and 0.3 ± 5.5 bpm for thoracic impedance. The proportions of RR values collected by acoustic method or by thoracic impedance which differed over 10 or 20% during more than 15 s, compared to capnometry, were 8.3 versus 14.3, and 1.5 versus 3.8%, respectively (p < 0.0001). The acoustic sensor had to be repositioned on three patients. For 11 patients, the Capnomask(®) was removed several times. In patients with drug or alcoholic poisoning, the acoustic method seems more accurate than thoracic impedance and better tolerated than face mask capnometry.
Published: 2015
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27. Combined frozen elephant trunk and endovascular repair for extensive thoracic aortic aneurysms

Author: Majid Harmouche, Olivier Fouquet, Jean-Philippe Verhoye, Erwan Flecher, Antoine Lucas, Amedeo Anselmi, Vito G. Ruggieri, Adrien Kaladji, Xavier Beneux, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], CHU Pontchaillou [Rennes], Service de chirurgie cardio-vasculaire et thoracique, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Europe FEDER, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Rennes (UR)-Hôpital Pontchaillou
Subjects: Aortic arch, Male, medicine.medical_specialty, Time Factors, Elephant trunks, Thoracic, Prosthesis Design, Aortography, Blood Vessel Prosthesis Implantation, Postoperative Complications, Risk Factors, medicine.artery, medicine, Humans, Common carotid artery, Prospective Studies, Cerebral perfusion pressure, Tomography, ComputingMilieux_MISCELLANEOUS, Aged, Aortic Aneurysm, Thoracic, business.industry, Endovascular Procedures, General Medicine, Middle Aged, Spinal cord, Collateral circulation, Trunk, 3. Good health, Surgery, X-Ray Computed, Blood Vessel Prosthesis, Aortic Aneurysm, medicine.anatomical_structure, Treatment Outcome, Descending aorta, Stents, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Radiology, France, Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, business
Abstract: Background We describe a 1-step treatment of extensive arch and descending aortic aneurysm by combination of frozen elephant trunk (FET) (hybrid endoprosthesis) and of conventional endoprosthesis deployment. Methods In a single-center, prospective, treatment-only study, the clinical data of 4 patients receiving combined FET and distal endoprosthesis deployment in the descending aorta were prospectively collected. Thoracic endoprostheses were deployed either retrogradely (off-pump from the femoral arterial access) or antegradely (from the aortic arch during hypothermic arrest). A distal-first approach was used (“trombone” mechanism). Spinal cord protection was achieved by transposition of the left subclavian artery to the left common carotid artery and selective antegrade cerebral perfusion. Preoperative computed tomography scan was performed to identify the collateral circulation. Preoperative planning was assisted by a sizing software (Endosize, Therenva Inc.). Results The aortic coverage was extended down to the orifice of the celiac trunk in one case and to the T8 level in the remainders. There was no operative mortality, 1 transient paraparesis, and 1 case of renal insufficiency. Follow-up results were satisfying (no device migration, no endoleak, no endotension, and no late neurologic complications). Conclusions The present strategy may abolish the risks connected with the waiting time between the surgical first step and the later completion (aortic-related adverse events and drop-out) and deserves further investigations to determine its safety and feasibility profile.
Published: 2015
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28. Is the EuroSCORE II best suited for reoperative risk estimation in patients with structural deterioration of aortic bioprostheses?

Author: Vito G. Ruggieri, Amedeo Anselmi, Vincent Auffret, Majid Harmouche, Jean-Philippe Verhoye, Hervé Le Breton, Xavier Beneux, Sophie Mascle, Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-Hôpital Pontchaillou, and Senhadji, Lotfi
Subjects: medicine.medical_specialty, Validation study, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, Heart Valve Diseases, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Logistic regression, Models, Biological, Risk Assessment, Euroscore ii, Aortic valve replacement, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, medicine, Humans, In patient, Structural valve deterioration Ϯ, Aorta, [SDV.IB] Life Sciences [q-bio]/Bioengineering, Valve-in-Valve implantation, business.industry, Patient Selection, valvular heart disease, Operative risk, EuroSCORE, General Medicine, Odds ratio, medicine.disease, Surgery, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Blood Vessel Prosthesis, Surgical Procedures, Operative, Cardiology, [SDV.IB]Life Sciences [q-bio]/Bioengineering, business, Algorithms
Abstract: International audience; Background - Operative risk prediction systems (logistic EuroSCORE I, EuroSCORE II and STS Score) are employed together with multidisciplinary discussion to contraindicate conventional surgery in patients with valvular heart disease and propose the employment of alternative transcatheter procedures. The EuroSCORE I has been reported to underperform in these circumstances; we hypothesize that the EuroSCORE II is best suited for the stratification of risk in patients with structural deterioration (SVD) of valvular bioprostheses and potential candidates to the Valve-in-Valve procedure (deployment of a transcatheter valve within a failing valvular bioprosthesis). Methods and evaluation of the hypothesis - A multi-institutional collaboration is required to fully address such hypothesis. Therefore, we performed a preliminary validation study by retrieval of the complete records of 81 patients undergoing reoperative aortic valve replacement for preoperative diagnosis of bioprosthetic SVD at our Institution. Logistic EuroSCORE I, EuroSCORE II and STS Score were calculated by preoperatively available data. Faced to an observed reoperative mortality of 4.9%, average EuroSCORE I was 15.8%±13.4, EuroSCORE II was 7.3%±7.4 and the STS Score was 15%±9.8. The three systems provided sufficient adequacy (Hosmer-Lemeshow p=0.847, p=0.999 and p=0.9948, respectively). Yet, the area under the ROC curve was significantly higher for the EuroSCORE II (0.9903) vs. the EuroSCORE I (0.8994) (p=0.044). The STS Score yielded an intermediate figure (0.9643). The odds ratios (logistic regression) were 1.079 for EuroSCORE I, 1.223 for the STS Score and 1.474 for EuroSCORE II. Conclusions - The three investigated algorithms showed reasonable calibration in the prediction of mortality for reoperative aortic valve replacement, but they evenly overestimated the observed mortality. The hypothesis that the EuroSCORE II is better suited for the selection of candidates to Valve-in-Valve implantation is worth of further multi-institutional investigations on the basis of our preliminary findings and due to the expanding role of transcatheter techniques.
Published: 2015
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29. Is extracorporeal membrane oxygenation for severe acute respiratory distress syndrome related to intra-abdominal sepsis beneficial?

Author: N. Nesseler, Sonia Isslame, Philippe Seguin, Yannick Mallédant, Erwan Flecher, Yoann Launey, Thomas Lebouvier, Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], CHU Pontchaillou [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: medicine.medical_specialty, ARDS, business.industry, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Acute respiratory distress, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, medicine.disease, 3. Good health, Sepsis, 03 medical and health sciences, Pneumonia, 0302 clinical medicine, 030228 respiratory system, Anesthesiology, medicine, Extracorporeal membrane oxygenation, business, Intensive care medicine, Transpulmonary pressure, Asthma
Abstract: International audience; Intra-abdominal sepsis (IAS) is frequently associated with acute respiratory distress syndrome (ARDS). Interest in extracorporeal membrane oxygenation (ECMO) as a therapeutic option in ARDS is increasing. However significant concerns remain about the most appropriate patient population which would benefit from the technique. Recent studies found that ARDS aetiologies such as pneumonia, asthma, trauma and burn or aspiration were associated with better outcomes [1–3]. Conversely, acute non-pulmonary-associated infections or a high number of organ failures were independent risk factors of mortality [1–3]. Thus the role of ECMO as a potentially useful therapeutic option in case of ARDS related to IAS remains questionable. We report 10 cases for which ECMO support was applied.
Published: 2015
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30. La dysfonction hépatique au cours du choc septique est associée à la mortalité a long terme

Author: Philippe Seguin, N. Nesseler, Jennifer White, Caroline Aninat, Yoann Launey, Yannick Mallédant, Anne Corlu, Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CHU Pontchaillou [Rennes], Jonchère, Laurent, Université de Rennes (UR)-Hôpital Pontchaillou, and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: [SDV] Life Sciences [q-bio], Anesthesiology and Pain Medicine, [SDV]Life Sciences [q-bio], 3. Good health
Abstract: National audience; Introduction Les données sur la dysfonction hépatique au cours du choc septique et son impact sur la mortalité sont limitées. Pourtant le foie apparaît comme un acteur majeur dans la réponse de l’hôte à l’agression. Pour répondre à cette question, une analyse post-hoc a été conduite à partir des données collectées au cours de l’essai Prospective Recombinant Human Activated Protein C Worldwide Évaluation in Severe Sepsis and Septic Shock (PROWESS-SHOCK). Au cours de cet essai une cohorte de 1697 patients en choc septique a été constituée [1]. Une première analyse avait montré que la dysfonction hépatique précoce (soit à l’inclusion dans l’essai) n’était pas associée à la mortalité [2]. Le but de cette étude était d’évaluer l’impact de la dysfonction hépatique survenant au cours du choc septique (soit après l’inclusion dans l’essai) sur la mortalité à court et à long terme. Patients et méthodes Tous les patients enrôlés dans PROWESS-SHOCK étaient inclus. La dysfonction hépatique à l’inclusion (baseline), soit dans les 24 h qui précédaient la perfusion de la drotrecogin alpha ou du placebo, était définie par un score Sequential Organ Function Assessement (SOFA) > 0. L’apparition d’une dysfonction hépatique uniquement après l’inclusion (période post-baseline) était définie par un SOFA hépatique > 0 durant la période post-baseline. L’aggravation durant la période post-baseline d’une dysfonction hépatique déjà présente à l’inclusion était définie par toute augmentation du SOFA hépatique post-baseline. La période post-baseline s’étendait depuis la perfusion de la drotrecogin alpha ou du placebo jusque j28. Le score SOFA était évalué à l’inclusion, quotidiennement jusque j7, puis à j14 et j28. Le critère de jugement principal était la mortalité à j180, les critères de jugement secondaires étaient la mortalité à j28 et j90. Le risque de décès a été estimé à l’aide de modèles de Cox à risques proportionnels. Résultats Le SOFA hépatique à l’inclusion a été évalué chez 1565 patients et 522 (33 %) présentait une dysfonction hépatique. Celle-ci n’était pas associé à la mortalité à j28 (HR : 0,847 [IC95 % : 0,647–1,109] ; p = 0,2267), j90 (HR : 0,883 [IC95 % : 0,701–1,112] ; p = 0,2892) et j180 (HR : 0,885 [IC95 % : 0,710–1,103] ; p = 0,2761). Quatre cent trois patients ont développé une dysfonction hépatique uniquement après l’inclusion (257/1043, 25 %) ou ont aggravé une dysfonction hépatique présente à l’inclusion (146/522, 28 %) durant les 28 jours de la période post-baseline. La médiane d’apparition ou d’aggravation de la dysfonction hépatique était de 2 (1–4) jours. Il existait une relation significative entre l’apparition ou l’aggravation de la dysfonction hépatique post-baseline et la mortalité à j28 (HR : 1,67 [IC95 % : 1,26–2,21] ; p = 0,0004), j90 (HR : 1,65 [IC95 % : 1,30–2,09] ; p < 0001) et j180 (HR : 1,57 [IC95 % : 1,26–1,97] ; p < .0001). Discussion L’apparition ou l’aggravation d’une dysfonction hépatique au cours du choc septique est significativement associée à la mortalité à long terme. Les patients en choc septique présentant une dysfonction hépatique pourraient bénéficier d’un suivi prolongé
Published: 2015
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31. Transitioning from routine to on-demand test ordering in intensive care units: a prospective, multicentre, interventional study

Author: Karim Asehnoune, Jeff Morcet, S. Lasocki, Philippe Seguin, P. Le Maguet, Soizic Gergaud, Olivier Mimoz, L. M. Autet, D. Demeure Dit Latte, Yannick Mallédant, M. Tanguy, Thomas Gaillard, CHU Pontchaillou [Rennes], Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité d'Investigation Clinique, Hôpital Pontchaillou, Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Service d'Anesthésie Réanimation [Rennes], Foie, métabolismes et cancer, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Jonchère, Laurent, Université de Rennes (UR)-Hôpital Pontchaillou, and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: Adult, Male, [SDV]Life Sciences [q-bio], Unnecessary Procedures, Positive correlation, Intensive care, On demand, Medical Staff, Hospital, Humans, Medicine, Social media, Prospective Studies, GeneralLiterature_REFERENCE(e.g.,dictionaries,encyclopedias,glossaries), ComputingMilieux_MISCELLANEOUS, Aged, Impact factor, Diagnostic Tests, Routine, business.industry, Advertising, Middle Aged, 3. Good health, [SDV] Life Sciences [q-bio], Intensive Care Units, Anesthesiology and Pain Medicine, Education, Medical, Continuing, Female, France, business, Test ordering
Abstract: interaction correlated with a positive change in their impact factor from their first adoption of Twitter to date. Recognizing that correlation does not imply causation, we examined this perceived relationship. Seven of 25 (28%) indexed anaesthesia journals have a Twitter account. We correlated Twitter presence, user/content interaction and validated metrics of social-media influence (Klout and BirdSong scores) with the journal’s current impact factor. We also looked at the change in impact factor since Twitter adoption by each journal and the number of article citations (Fig. 1). Comparison was made with the change in impact factor of anaesthesia journals without Twitter accounts over the same period. An active Twitter account with a high Klout score directlycorrelated with higher journal impact factor (P=0.034) and with a greater number of article citations (P=0.016) than journals not embracing social media. A highly-performing Twitter account was also associated with an increase in impact factor in the period after Twitter adoption (P=0.01), while journals without a social media presence, on average, saw a net stasis or decline in their impact factor. Twitter offers a unique platform for fast dissemination and discussion of the latest publications in anaesthesia. With smartphones and tablet devices allowing constant access to social media, anaesthetists communicate via social media to discuss journal publications and respond to journal editors. To encourage further adoption by our academic journals, we share our observations of a positive correlation between journal editorial interaction on Twitter and a subsequent increase in journal impact factor. Journals which did not actively embrace Twitter as a 21st-century Letter to (and from) the Editor saw a net stasis or even decline in impact factor.
Published: 2015
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32. Population Pharmacokinetics of Amitriptyline After Intrathecal, Epidural, and Intravenous Administration in Sheep

Author: William Couet, Claude Ecoffey, Nicolas Grégoire, G. Dollo, David Bec, François Chevanne, Pascal Le Corre, Jean-Pierre C. Estebe, Maja Ratajczak-Enselme, Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], Pharmacologie des anti-infectieux (PHAR), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Laboratoire de Pharmacie Galenique, Biopharmacie et Pharmacie Clinique, Université de Rennes 1 (UR1), Université de Rennes (UR)-Hôpital Pontchaillou, Laboratoire de Pharmacie Galenique, Biopharmacie et Pharmacie Clinique [Rennes], and Université de Rennes (UR)
Subjects: Epidural Space, Microdialysis, medicine.drug_class, Amitriptyline, health care facilities, manpower, and services, [SDV]Life Sciences [q-bio], Population, Analgesic, Injections, Epidural, Tricyclic antidepressant, 03 medical and health sciences, 0302 clinical medicine, Pharmacokinetics, 030202 anesthesiology, parasitic diseases, medicine, Animals, cardiovascular diseases, education, Injections, Spinal, health care economics and organizations, education.field_of_study, Sheep, business.industry, General Medicine, Analgesics, Non-Narcotic, Epidural space, 3. Good health, Bioavailability, Analgesia, Epidural, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Anesthesia, Administration, Intravenous, Female, business, 030217 neurology & neurosurgery, medicine.drug
Abstract: International audience; Background - Amitriptyline (AMI) is a lipophilic, tricyclic antidepressant with analgesic properties that could potentially be used for epidural (EPI) analgesia. However, no pharmacokinetic data are available for AMI in spinal spaces. The objective of this study was to evaluate the spinal disposition and intrathecal (IT) bioavailability of AMI after IT and EPI administration. Methods - Six Lacaune ewes received 3 consecutive administrations of AMI. They initially received 10 mg of AMI administered intravenously, then 5 mg of AMI administered intrathecally, and 50 mg of AMI injected into the EPI space. Consecutive administrations were separated by intervals of 2 hours. A simultaneous microdialysis technique was used to determine the EPI and IT concentrations of AMI. Population analysis with S-ADAPT software was used to evaluate the pharmacokinetic parameters. Results - Following intravenous administration, the clearance and central compartment (Vc) in plasma were 1.32 L/min and 147 L, respectively. Concentration-time profiles for the IT and EPI compartments were highly variable after transmeningeal diffusion. The IT Vc after IT administration and the EPI Vc after EPI administration were 2.4 and 48.9 mL, respectively. Less AMI transferred from the EPI to the IT space than from the IT to the EPI compartment, with bioavailabilities of 1.3% and 55%, respectively. Conclusions - Simultaneous population analysis for AMI demonstrated differences in EPI and IT pharmacokinetics following the EPI and IT administration of this drug. The IT bioavailability of AMI after EPI administration is relatively low.
Published: 2015
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33. Effect of a fever control protocol-based strategy on ventilator-associated pneumonia in severely brain-injured patients

Author: Yoann Launey, Philippe Seguin, Yannick Mallédant, Ronan Garlantézec, Audren Le Cousin, N. Nesseler, Fanny Feuillet, Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Biostatistique, Recherche Clinique et Mesures Subjectives en Santé, Université de Nantes (UN), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université d'Angers (UA)-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: medicine.medical_specialty, business.industry, Research, [SDV]Life Sciences [q-bio], Pneumonia ventilator associated, Critical Care and Intensive Care Medicine, medicine.disease, bacterial infections and mycoses, 3. Good health, Fever therapy, respiratory tract diseases, 03 medical and health sciences, On ventilator, Pneumonia, 0302 clinical medicine, 030228 respiratory system, Severity of illness, medicine, Observational study, Intensive care medicine, business, Prospective cohort study, 030217 neurology & neurosurgery, Cohort study
Abstract: International audience; IntroductionFever is associated with a poor outcome in severely brain-injured patients, and its control is one of the therapies used in this condition. But, fever suppression may promote infection, and severely brain-injured patients are frequently exposed to infectious diseases, particularly ventilator-associated pneumonia (VAP). Therefore, we designed a study to explore the role of a fever control protocol in VAP development during neuro-intensive care.MethodsAn observational study was performed on severely brain-injured patients hospitalized in a university ICU. The primary goal was to assess whether fever control was a risk factor for VAP in a prospective cohort in which a fever control protocol was applied and in a historical control group. Moreover, the density of VAP incidence was compared between the two groups. The statistical analysis was based on a competing risk model multivariate analysis.ResultsThe study included 189 brain-injured patients (intervention group, n¿=¿98, and historical control group, n¿=¿91). The use of a fever control protocol was an independent risk factor for VAP (hazard ratio 2.73, 95% confidence interval [1.38, 5.38; P¿=¿0.005]). There was a significant increase in the incidence of VAP in patients treated with a fever control protocol (26.1 versus 12.5 VAP cases per 1000 days of mechanical ventilation). In cases in which a fever control protocol was applied for >3 days, we observed a higher rate of VAP in comparison with the rate among patients treated for ¿3 days.ConclusionFever control in brain-injured patients was a major risk factor for VAP occurrence, particularly when applied for >3 days.
Published: 2014
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34. High-Dose Continuous Oxacillin Infusion Results in Achievement of Pharmacokinetics Targets in Critically Ill Patients with Deep Sternal Wound Infections following Cardiac Surgery

Author: Caroline Piau, Nicolas Nesseler, Marine Dermu, Yoann Launey, Alexandre Malherbe, Yannick Mallédant, Olivier Tribut, Philippe Seguin, Erwan Flecher, Marie-Clémence Verdier, Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Pharmacologie [Rennes], CHU Pontchaillou [Rennes], Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Male, medicine.medical_specialty, Staphylococcus aureus, [SDV]Life Sciences [q-bio], Critical Illness, Microbial Sensitivity Tests, medicine.disease_cause, Loading dose, 03 medical and health sciences, 0302 clinical medicine, Pharmacokinetics, Interquartile range, medicine, Humans, Pharmacology (medical), 030212 general & internal medicine, Prospective Studies, Cardiac Surgical Procedures, Infusions, Intravenous, Aged, Oxacillin, Pharmacology, 0303 health sciences, 030306 microbiology, Septic shock, business.industry, Liter, Staphylococcal Infections, medicine.disease, 3. Good health, Cardiac surgery, Anti-Bacterial Agents, Infectious Diseases, Anesthesia, Bacteremia, Wound Infection, Female, business
Abstract: Knowledge regarding antimicrobial therapy strategies in deep sternal wound infections (DSWI) following cardiac surgery is limited. Therefore, we aimed to determine the steady-state plasma and mediastinal concentrations of oxacillin administered by continuous infusion in critically ill patients with DSWI and to compare these concentrations with the susceptibility of staphylococci recovered. A continuous infusion of oxacillin (150 to 200 mg/kg of body weight/24 h) was administered after a loading dose (50 mg/kg). Plasma and mediastinal concentrations of total and unbound oxacillin were determined 4 h after the loading dose (H4) and then at day 1 (H24) and day 2 (H48). Twelve patients were included. Nine patients exhibited bacteremia, 5 were in septic shock, 8 were positive for Staphylococcus aureus , and 4 were positive for coagulase-negative staphylococci. The median MIC (first to third interquartile range) was 0.25 (0.24 to 0.41) mg/liter. Median plasma concentrations of total and unbound oxacillin at H4, H24, and H48 were, respectively, 64.4 (41.4 to 78.5) and 20.4 (12.4 to 30.4) mg/liter, 56.9 (31.4 to 80.6) and 21.7 (6.5 to 27.3) mg/liter, and 57.5 (32.2 to 85.1) and 20 (14.3 to 35.7) mg/liter. The median mediastinal concentrations of total and unbound oxacillin at H4, H24, and H48 were, respectively, 2.3 (0.7 to 25.9) and 0.9 (
Published: 2014
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35. Mid-term results of elective repair of extensive thoracic aortic pathology by the Evita Open Plus hybrid endoprosthesis only.: Follow-up of the Evita Open Plus

Author: Verhoye, Jean-Philippe, Anselmi, Amedeo, Kaladji, Adrien, Flécher, Erwan, Lucas, Antoine, Heautot, Jean-François, Beneux, Xavier, Fouquet, Olivier, Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes], Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Service de chirurgie cardio-vasculaire et thoracique, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Pontchaillou-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)
Subjects: [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Endovascular procedures, Aortic operation, cardiovascular system, [SDV.IB]Life Sciences [q-bio]/Bioengineering, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Hybrid surgery
Abstract: International audience; OBJECTIVES: To describe the early and mid-term clinical and instrumental results of the frozen elephant trunk (FET) procedure using the recent Evita Open Plus hybrid endoprosthesis for elective one-stage treatment of extensive thoracic aortic disease. METHODS: We reviewed 16 patients undergoing FET for post-dissection aneurysm (50%), true aneurysm (31%) or other aetiologies (19%), through median sternotomy and hypothermic circulatory arrest. An average 14 ± 7.6-month follow-up with regular contrast-enhanced control computed tomography scans was available. Four patients received preliminary carotid-subclavian bypass to improve spinal cord protection. Distal extension through endovascular deployment of stent-grafts into the descending aorta was performed during the same procedure in 3 patients. Concomitant procedures on the ascending aorta/root were done in 25% of cases. RESULTS: There were no cases of operative mortality. Cases of neither cerebral stroke nor postoperative paraplegia were observed. Two cases of transient paraparesis and 1 case of Brown-Séquard syndrome occurred. At follow-up, there were no cases of endoleak or endotension. One patient was reoperated for distal completion (thoracoabdominal aortic replacement). CONCLUSIONS: The FET using the Evita Open Plus device is a reliable and versatile treatment for one-step management of extensive disease of the aortic arch and the descending aorta. This strategy should be reserved for patients having limited preoperative comorbidities and good functional status.
Published: 2014
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36. Mort encéphalique : vers de nouveaux critères de confirmation angioscannographique ?

Author: Hélène Raoult, J.Y. Gauvrit, Philippe Seguin, Yannick Mallédant, A. Marchand, Jean-Christophe Ferré, Département de Radiologie [CHU de Rennes], Université de Rennes (UR), Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Service d'Anesthésie Réanimation [Rennes], CHU Pontchaillou [Rennes], Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Vision, Action et Gestion d'informations en Santé (VisAGeS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Inria Rennes – Bretagne Atlantique, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE (IRISA-D5), Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-Télécom Bretagne-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-Télécom Bretagne-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Télécom Bretagne-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), CentraleSupélec-Télécom Bretagne-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de Recherche en Informatique et en Automatique (Inria)-École normale supérieure - Rennes (ENS Rennes)-Université de Bretagne Sud (UBS)-Centre National de la Recherche Scientifique (CNRS)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-CentraleSupélec-Télécom Bretagne-Université de Rennes 1 (UR1), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École normale supérieure - Rennes (ENS Rennes)-Université de Bretagne Sud (UBS)-Centre National de la Recherche Scientifique (CNRS)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), and Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)
Subjects: 03 medical and health sciences, 0302 clinical medicine, Radiological and Ultrasound Technology, [SDV]Life Sciences [q-bio], Radiology, Nuclear Medicine and imaging, Neurology (clinical), 030217 neurology & neurosurgery, 030218 nuclear medicine & medical imaging
Abstract: National audience; Objectifs.– Étudier l’opacification en angioscanner de l’artère basilaire et des veines de fosse postérieure en situation de mort encéphalique clinique afin d’identifier de nouveaux critères scannographiques mieux corrélés avec les critères cliniques. Patients et méthodes.– Trente-trois patients consécutifs explorés en angioscanner pour confirmer le diagnostic clinique de mort encéphalique ont été rétrospectivement inclus de juillet 2011 à juillet 2012. L’analyse des images relevait.–l’opacification des artères cérébrales moyennes en M4 et des veines cérébrales internes (critères de référence pour le diagnostic d’arrêt circulatoire) ainsi que de l’artère basilaire et des veines de fosse postérieure (réseau pétreux et vermien). Résultats.– Trente-six angioscanners ont été réalisés : pour 3 patients, deux angioscanners successifs ont été effectués en raison de la négativité du premier. Les 4 critères de référence étaient remplis sur 32 angioscanners (89 %) : les artères M4 restaient opacifiés sur 4 scanners dont 1 pour lequel les veines cérébrales internes, les veines pétreuses et les veines vermiennes étaient aussi opacifiées. Ce dernier scanner était le seul examen parmi les 36 réalisés pour lequel les veines pétreuses et des veines cérébrales internes étaient opacifiées. Les veines vermiennes restaient opacifiées sur 2 scanners (avec artères M4 toujours opacifiées) et l’artère basilaire sur 7 scanners (dont 6 avec critères de référence remplis). Parmi 5 scanners réalisés chez des patients avec craniectomie, les artères M4 restaient opacifiées sur 1 examen alors que les veines pétreuses et les veines cérébrales internes n’étaient jamais opacifiées. La non opacification conjointe des veines cérébrales internes et des veines pétreuses obtenait une sensibilité de 97 % pour le diagnostic angioscannographique d’arrêt circulatoire encéphalique (versus 89 % pour les critères de référence). Conclusion.– La non opacification conjointe des veines pétreuses et des veines cérébrales internes permet d’augmenter la sensibilité du diagnostic angioscannographique d’arrêt circulatoire encéphalique, y compris chez les patients avec craniectomie.
Published: 2014
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37. Complications associated with 27 031 ultrasound-guided axillary brachial plexus blocks: a web-based survey of 36 French centres

Author: Emmanuel Oger, Yann Cimino, Claude Ecoffey, Hélène Beloeil, Florence Marchand-Maillet, Jean-Jérome Rannou, Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), CIC-IT Rennes, Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Pharmacologie [Rennes], CHU Pontchaillou [Rennes], Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes (UR)-Hôpital Pontchaillou, and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: Adult, Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, medicine, Humans, Prospective Studies, Prospective cohort study, Case report form, Ultrasonography, Interventional, Web based survey, Internet, business.industry, Data Collection, Incidence (epidemiology), Middle Aged, Brachial Plexus Block, Ultrasound guided, 3. Good health, Surgery, Anesthesiology and Pain Medicine, Cohort, Female, Observational study, France, business, Brachial plexus, 030217 neurology & neurosurgery
Abstract: International audience; BACKGROUND: Ultrasound guidance improves the efficacy of peripheral nerve blocks, reducing performance time and local anaesthetic doses. It should also reduce the risk of systemic toxicity of local anaesthetic and nerve injuries. OBJECTIVE: The primary objective of this prospective study was to estimate the incidence of immediate complications related to ultrasound-guided axillary brachial plexus blocks in a multicentre observational cohort. DESIGN: Prospective multicentre observational study. SETTING: Thirty-six French centres participated in the study between 2009 and 2012. PATIENTS: A total of 27 031 axillary brachial plexus blocks were recorded. INTERVENTIONS: The study objective, the incidence of immediate complications related to ultrasound-guided axillary brachial plexus blocks (intravascular injection of local anaesthetic and neurological deficit at hospital discharge), was based on data collected by anaesthesiologists through a web-based case report form. MAIN OUTCOME MEASURE: Incidence of immediate complications related to ultrasound-guided axillary brachial plexus blocks. RESULTS: Of 27 031 blocks performed, the incidence of systemic toxicity of local anaesthetic was very low at 1.5 per 10 000, and the overall incidence of postoperative neurological symptoms was 0.37 per 10 000. CONCLUSION: We have reported a large series of ultrasound-guided axillary brachial plexus blocks in a multicentre study. Our results confirm the low incidence of local anaesthetic systemic toxicity and postoperative neurological complications as previously described.
Published: 2014
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38. Mid-term results of elective repair of extensive thoracic aortic pathology by the Evita Open Plus hybrid endoprosthesis only.: Follow-up of the Evita Open Plus

Author: Verhoye, Jean-Philippe, Anselmi, Amedeo, Kaladji, Adrien, Flécher, Erwan, Lucas, Antoine, Heautot, Jean-François, Beneux, Xavier, Fouquet, Olivier, Senhadji, Lotfi, Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes], Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Service de chirurgie cardio-vasculaire et thoracique, Centre Hospitalier Universitaire d'Angers (CHU Angers), and PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM)
Subjects: [SDV.IB] Life Sciences [q-bio]/Bioengineering, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Endovascular procedures, Aortic operation, cardiovascular system, [SDV.IB]Life Sciences [q-bio]/Bioengineering, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Hybrid surgery, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
Abstract: International audience; OBJECTIVES: To describe the early and mid-term clinical and instrumental results of the frozen elephant trunk (FET) procedure using the recent Evita Open Plus hybrid endoprosthesis for elective one-stage treatment of extensive thoracic aortic disease. METHODS: We reviewed 16 patients undergoing FET for post-dissection aneurysm (50%), true aneurysm (31%) or other aetiologies (19%), through median sternotomy and hypothermic circulatory arrest. An average 14 ± 7.6-month follow-up with regular contrast-enhanced control computed tomography scans was available. Four patients received preliminary carotid-subclavian bypass to improve spinal cord protection. Distal extension through endovascular deployment of stent-grafts into the descending aorta was performed during the same procedure in 3 patients. Concomitant procedures on the ascending aorta/root were done in 25% of cases. RESULTS: There were no cases of operative mortality. Cases of neither cerebral stroke nor postoperative paraplegia were observed. Two cases of transient paraparesis and 1 case of Brown-Séquard syndrome occurred. At follow-up, there were no cases of endoleak or endotension. One patient was reoperated for distal completion (thoracoabdominal aortic replacement). CONCLUSIONS: The FET using the Evita Open Plus device is a reliable and versatile treatment for one-step management of extensive disease of the aortic arch and the descending aorta. This strategy should be reserved for patients having limited preoperative comorbidities and good functional status.
Published: 2014
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39. The Accuracy of Transcutaneous PCO2 in Subjects With Severe Brain Injury: A Comparison With End-Tidal PCO2

Author: Philippe Seguin, Jean-Paul Bleichner, Bruno Laviolle, Alice Jouve, Yoann Launey, Sébastien Rosier, Yannick Mallédant, Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service de réanimation chirurgicale, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Pharmacologie [Rennes], CHU Pontchaillou [Rennes], Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes (UR)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, and Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Adult, Male, Pulmonary and Respiratory Medicine, [SDV]Life Sciences [q-bio], Respiratory monitoring, Critical Care and Intensive Care Medicine, Transcutaneous pco2, pCO2, 03 medical and health sciences, 0302 clinical medicine, Respiratory Rate, Predictive Value of Tests, Tidal Volume, Humans, Arterial blood gas analysis, Medicine, In patient, Prospective Studies, business.industry, Limits of agreement, 030208 emergency & critical care medicine, General Medicine, Middle Aged, Arterial catheter, End tidal pco2, Respiration, Artificial, respiratory tract diseases, 030228 respiratory system, Brain Injuries, Anesthesia, Regression Analysis, Female, Nuclear medicine, business, Blood Gas Monitoring, Transcutaneous, circulatory and respiratory physiology
Abstract: International audience; BACKGROUND: In patients suffering from brain injury, end-tidal PCO2 (PETCO2 ) monitoring is controversial, but transcutaneous PCO2 (PtcCO2 ), which is noninvasive and utilizes immediate display, may be an alternative method. We hypothesized that PtcCO2 would be more accurate than PETCO2 for monitoring PaCO2 in patients with severe brain injury. METHODS: A prospective observational study included consecutive mechanically ventilated adult subjects who had acute brain injury and an arterial catheter in place. When an arterial blood gas analysis was required, the PETCO2 and PtcCO2 values were simultaneously recorded. The agreement between the PETCO2 , PtcCO2 , and PaCO2 measurements (reference) was determined using the Bland-Altman method. The number of outliers defined by the formula ([PETCO2 or PtcCO2 ] - PaCO2 ) \textgreater ± 4 mm Hg indicated the proportion of measurements that were considered clinically unacceptable. RESULTS: A total of 25 subjects were included in the study, and 85 simultaneous measurements of PaCO2 , PtcCO2 , and PETCO2 were obtained. The bias and precision between PaCO2 and PtcCO2 were -0.75 and 6.23 mm Hg, respectively. The limits of agreement ranged from -12.97 to 11.47 mm Hg. The bias and precision between PaCO2 and PETCO2 were 0.68 and 5.82 mm Hg, respectively. The limits of agreement ranged from -10.72 to 12.08 mm Hg. There were 34 (40%) outliers for the PtcCO2 sensor and 34 (40%) outliers for the PETCO2 sensor (P \textgreater .99). CONCLUSIONS: The accuracy of PtcCO2 was not superior to that of PETCO2 for assessing PCO2 levels and should not be used to monitor these levels in subjects with severe brain injury.
Published: 2014
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40. Fludrocortisone and hydrocortisone, alone or in combination, on in vivo hemodynamics and in vitro vascular reactivity in normal and endotoxemic rats: a randomized factorial design study

Author: Bruno Laviolle, Eric Bellissant, Catherine Massart, Nicolas Nesseler, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Pharmacologie [Rennes], CHU Pontchaillou [Rennes], Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Service d'Hormonologie, CHU Pontchaillou [Rennes]-Hôpital Pontchaillou, Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Rennes (UR)-Hôpital Pontchaillou
Subjects: Male, medicine.medical_specialty, Hydrocortisone, Fludrocortisone, [SDV]Life Sciences [q-bio], Wistar, Hemodynamics, Random Allocation, Organ Culture Techniques, Drug Therapy, Internal medicine, medicine, Animals, Rats, Wistar, Mesenteric arteries, Phenylephrine, Pharmacology, Septic shock, business.industry, medicine.disease, Endotoxemia, 3. Good health, Rats, medicine.anatomical_structure, Blood pressure, Endocrinology, Vasoconstriction, Combination, Drug Therapy, Combination, medicine.symptom, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract: International audience; Hydrocortisone enhances the pressor response to catecholamines in healthy volunteers and septic shock patients. Similar data do not exist for fludrocortisone. We assessed the effects of single administrations of fludrocortisone and hydrocortisone on systolic blood pressure until 2 hours after treatments injection and on in vitro vascular contraction of mesenteric artery rings to phenylephrine at 3 hours, in normal and endotoxemic rats. Intravenous fludrocortisone (5 and 20 μg/kg) and hydrocortisone (4 and 20 mg/kg) were administered in 16 groups (8 without and 8 with lipopolysaccharide-induced endotoxemic shock) of 10 Wistar rats according to four 2 × 2-factorial designs. Fludrocortisone and hydrocortisone similarly increased systolic blood pressure (P \textless 0.001 for both) but more in endotoxemic than in normal animals. Fludrocortisone and hydrocortisone significantly modified contractile response to phenylephrine (P = 0.039 and P = 0.007, respectively). At dose 1, fludrocortisone had no effect and hydrocortisone decreased contraction, whereas, at dose 2, both fludrocortisone and hydrocortisone increased contraction, especially in endotoxemic rats and with additive effect. Our results show that single intravenous administrations of fludrocortisone and hydrocortisone increase blood pressure and contractile response of mesenteric arteries to phenylephrine. The magnitude of these effects depends on dose and pathophysiological conditions and is higher in endotoxemic than in normal rats.
Published: 2014
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41. Prevalence of iron deficiency on ICU discharge and its relation with fatigue: a multicenter prospective study

Author: Yannick Mallédant, Déborah Tartière, Nicolas Chudeau, Laurence Carlier, Jean François Hamel, Thibaut Papet, Olivier Mimoz, Antoine Roquilly, Karim Asehnoune, Philippe Seguin, Sigismond Lasocki, Pôle d'Anesthésie Réanimation, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Service d'Anesthésie-Réanimation 1, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service d'Anesthésie-Réanimation [CHU Limoges], CHU Limoges, 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), Service d'anesthésie réanimation [Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), Modélisations pharmacocinétiques-pharmacodynamiques pour un meilleur usage des anti-infectieux, Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Poitiers, Foie, métabolismes et cancer, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), PRES Université Nantes Angers Le Mans (UNAM), Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Poitiers, Université de Rennes (UR)-Hôpital Pontchaillou, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Jonchère, Laurent
Subjects: Adult, Male, medicine.medical_specialty, Visual analogue scale, Anemia, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Grip strength, 0302 clinical medicine, Internal medicine, Intensive care, 80 and over, Prevalence, Medicine, Humans, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Fatigue, Aged, Aged, 80 and over, Muscle Weakness, Anemia, Iron-Deficiency, biology, business.industry, Transferrin saturation, Research, Muscle weakness, Iron-Deficiency, Middle Aged, medicine.disease, Patient Discharge, Surgery, [SDV] Life Sciences [q-bio], Ferritin, Intensive Care Units, biology.protein, Female, medicine.symptom, business
Abstract: International audience; INTRODUCTION: Prevalence of iron deficiency (ID) at intensive care (ICU) admission is around 25 to 40%. Blood losses are important during ICU stay, leading to iron losses, but prevalence of ID at ICU discharge is unknown. ID has been associated with fatigue and muscular weakness, and may thus impair post-ICU rehabilitation. This study assessed ID prevalence at ICU discharge, day 28 (D28) and six months (M6) after and its relation with fatigue. METHODS: We conducted this prospective, multicenter observational study at four University hospitals ICUs. Anemic (hemoglobin (Hb) less than 13 g/dL in male and less than 12 g/dL in female) critically ill adult patients hospitalized for at least five days had an iron profile taken at discharge, D28 and M6. ID was defined as ferritin less than 100 ng/L or less than 300 ng/L together with a transferrin saturation less than 20%. Fatigue was assessed by numerical scale and the Multidimensional Fatigue Inventory-20 questionnaire at D28 and M6 and muscular weakness by a hand grip test at ICU discharge. RESULTS: Among 107 patients (men 77%, median (IQR) age 63 (48 to 73) years) who had a complete iron profile at ICU discharge, 9 (8.4%) had ID. At ICU discharge, their hemoglobin concentration (9.5 (87.7 to 10.3) versus 10.2 (92.2 to 11.7) g/dL, P =0.09), hand grip strength (52.5 (30 to 65) versus 49.5 (15.5 to 67.7)% of normal value, P =0.61) and visual analog scale fatigue scale (57 (40 to 80) versus 60 (47.5 to 80)/100, P =0.82) were not different from non-ID patients. At D28 (n =80 patients) and M6 (n =78 patients), ID prevalence increased (to 25 and 35% respectively) while anemia prevalence decreased (from 100% to 80 and 25% respectively, P \textless0.0001). ID was associated with increased fatigue at D28, after adjustment for main confounding factors, including anemia (regression coefficient (95%CI), 3.19 (0.74 to 5.64), P =0.012). At M6, this association disappeared. CONCLUSIONS: The prevalence of ID increases from 8% at discharge to 35% six months after prolonged ICU stay (more than five days). ID was associated with increased fatigue, independently of anemia, at D28
Published: 2014
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42. Phenotypic spectrum of probable and genetically-confirmed idiopathic basal ganglia calcification

Author: Gaël, Nicolas, Cyril, Pottier, Camille, Charbonnier, Lucie, Guyant-Maréchal, Isabelle, Le Ber, Jérémie, Pariente, Pierre, Labauge, Xavier, Ayrignac, Luc, Defebvre, David, Maltête, Olivier, Martinaud, Romain, Lefaucheur, Olivier, Guillin, David, Wallon, Boris, Chaumette, Philippe, Rondepierre, Nathalie, Derache, Guillaume, Fromager, Stéphane, Schaeffer, Pierre, Krystkowiak, Christophe, Verny, Snejana, Jurici, Mathilde, Sauvée, Marc, Vérin, Thibaud, Lebouvier, Olivier, Rouaud, Christel, Thauvin-Robinet, Stéphane, Rousseau, Anne, Rovelet-Lecrux, Thierry, Frebourg, Dominique, Campion, Didier, Hannequin, Service de neurologie [Rouen], CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ), Génétique médicale et fonctionnelle du cancer et des maladies neuropsychiatriques, Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière ( CRICM ), Centre National de la Recherche Scientifique ( CNRS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ), Imagerie cérébrale et handicaps neurologiques, Université Paul Sabatier - Toulouse 3 ( UPS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Neurologie vasculaire, pathologie neuro-dégénérative et explorations fonctionnelles du système nerveux [Toulouse], Université Paul Sabatier - Toulouse 3 ( UPS ) -CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], Centre de résonance magnétique biologique et médicale ( CRMBM ), Aix Marseille Université ( AMU ) -Assistance Publique - Hôpitaux de Marseille ( APHM ) -Centre National de la Recherche Scientifique ( CNRS ), CHU Rouen, Génétique du cancer et des maladies neuropsychiatriques ( GMFC ), Service de neurochirurgie [Rouen], Department of Biology [Utah], University of Utah, Service de neurologie [Amiens], CHU Amiens-Picardie, Service de Gérontologie ( BICETRE - Géronto ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Bicêtre, Comportement et noyaux gris centraux [Rennes], Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Université européenne de Bretagne ( UEB ) -CHU Pontchaillou [Rennes]-Institut des Neurosciences Cliniques de Rennes (INCR), Service de Neurologie [Rennes], Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service d'anesthésie réanimation chirurgicale, Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou, Foie, métabolismes et cancer, Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service de Neurologie, Université Montpellier 1 ( UM1 ) -Hôpital Guy de Chauliac-Centre Mémoire Ressources Recherche Languedoc - Roussillon, Génétique des Anomalies du Développement ( GAD ), Université de Bourgogne ( UB ) -IFR100 - Structure fédérative de recherche Santé-STIC, Centre de génétique - Centre de référence des maladies rares, anomalies du développement et syndromes malformatifs (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (CRICM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Imagerie cérébrale et handicaps neurologiques (ICHN), 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), 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)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Centre de résonance magnétique biologique et médicale (CRMBM), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS), Normandie Université (NU)-Normandie Université (NU), Génétique du cancer et des maladies neuropsychiatriques (GMFC), Service de neurochirurgie [CHU Rouen], Service de Gérontologie (BICETRE - Géronto), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Comportement et noyaux gris centraux = Behavior and Basal Ganglia [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université européenne de Bretagne - European University of Brittany (UEB)-CHU Pontchaillou [Rennes]-Institut des Neurosciences Cliniques de Rennes (INCR), Service de Neurologie [Rennes] = Neurology [Rennes], CHU Pontchaillou [Rennes], Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université Montpellier 1 (UM1)-Hôpital Guy de Chauliac-Centre Mémoire Ressources Recherche Languedoc - Roussillon, Génétique des Anomalies du Développement (GAD), IFR100 - Structure fédérative de recherche Santé-STIC-Université de Bourgogne (UB), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Université de Bourgogne (UB)-IFR100 - Structure fédérative de recherche Santé-STIC, Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Centre Hospitalier Universitaire de Toulouse (CHU 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 de Toulouse (UT)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université de Rennes (UR)-Université européenne de Bretagne - European University of Brittany (UEB)-CHU Pontchaillou [Rennes]-Institut des Neurosciences Cliniques de Rennes = Institute of Clinical Neurosciences of Rennes (INCR), Université de Rennes (UR)-Hôpital Pontchaillou, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université Montpellier 1 (UM1)-Hôpital Gui de Chauliac [CHU Montpellier], and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Centre Mémoire Ressources Recherche Languedoc - Roussillon
Subjects: Adult, Male, Pathology, medicine.medical_specialty, Movement disorders, [SDV]Life Sciences [q-bio], Basal ganglia calcification, PDGFRB, Biology, Asymptomatic, Receptor, Platelet-Derived Growth Factor beta, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Basal Ganglia Diseases, Basal ganglia, medicine, Humans, Single-Blind Method, 030304 developmental biology, Aged, Aged, 80 and over, 0303 health sciences, [ SDV ] Life Sciences [q-bio], Genetic heterogeneity, Sodium-Phosphate Cotransporter Proteins, Type III, Calcinosis, Neurodegenerative Diseases, Middle Aged, medicine.disease, 3. Good health, Pedigree, Phenotype, Etiology, Female, Neurology (clinical), medicine.symptom, Tomography, X-Ray Computed, 030217 neurology & neurosurgery, Calcification
Abstract: International audience; Idiopathic basal ganglia calcification is characterized by mineral deposits in the brain, an autosomal dominant pattern of inheritance in most cases and genetic heterogeneity. The first causal genes, SLC20A2 and PDGFRB, have recently been reported. Diagnosing idiopathic basal ganglia calcification necessitates the exclusion of other causes, including calcification related to normal ageing, for which no normative data exist. Our objectives were to diagnose accurately and then describe the clinical and radiological characteristics of idiopathic basal ganglia calcification. First, calcifications were evaluated using a visual rating scale on the computerized tomography scans of 600 consecutively hospitalized unselected controls. We determined an age-specific threshold in these control computerized tomography scans as the value of the 99th percentile of the total calcification score within three age categories: 60 years. To study the phenotype of the disease, patients with basal ganglia calcification were recruited from several medical centres. Calcifications that rated below the age-specific threshold using the same scale were excluded, as were patients with differential diagnoses of idiopathic basal ganglia calcification, after an extensive aetiological assessment. Sanger sequencing of SLC20A2 and PDGFRB was performed. In total, 72 patients were diagnosed with idiopathic basal ganglia calcification, 25 of whom bore a mutation in either SLC20A2 (two families, four sporadic cases) or PDGFRB (one family, two sporadic cases). Five mutations were novel. Seventy-one per cent of the patients with idiopathic basal ganglia calcification were symptomatic (mean age of clinical onset: 39 ± 20 years; mean age at last evaluation: 55 ± 19 years). Among them, the most frequent signs were: cognitive impairment (58.8%), psychiatric symptoms (56.9%) and movement disorders (54.9%). Few clinical differences appeared between SLC20A2 and PDGFRB mutation carriers. Radiological analysis revealed that the total calcification scores correlated positively with age in controls and patients, but increased more rapidly with age in patients. The expected total calcification score was greater in SLC20A2 than PDGFRB mutation carriers, beyond the effect of the age alone. No patient with a PDGFRB mutation exhibited a cortical or a vermis calcification. The total calcification score was more severe in symptomatic versus asymptomatic individuals. We provide the first phenotypical description of a case series of patients with idiopathic basal ganglia calcification since the identification of the first causative genes. Clinical and radiological diversity is confirmed, whatever the genetic status. Quantification of calcification is correlated with the symptomatic status, but the location and the severity of the calcifications don't reflect the whole clinical diversity. Other biomarkers may be helpful in better predicting clinical expression.
Published: 2013
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43. Douleurs Chroniques et Anesthesie Loco-Régionale chez l'Enfant. [Chronic pain and regional anesthesia in children.]

Author: Dadure, Christophe, Marec, Perrine, Veyckemans, Francis, Beloeil, Hélène, Département d'Anesthésie et Réanimation Lapeyronie, Hôpital Lapeyronie [Montpellier] (CHU), Unité de Traitement de la Douleur de l'Enfant, Institut d'Hématologie et d'Oncologie Pédiatrie, Service d'Anesthésiologie, Cliniques Universitaires Saint-Luc [Bruxelles], Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou
Subjects: douleur chronique, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, anesthésie locorégionale, enfants
Abstract: International audience; Chronic pain is usually underestimated in children, due to lack of knowledge and to its specific semiotic. In addition to suffering, chronic pain causes a physical, psychological, emotional, social and financial burden for the child and his family. The practitioners may find themselves in a situation of failure with depletion of medical resources. Some types of chronic pain are refractory to conventional systemic treatment and may require the use of regional anesthesia. Cancer pain is common in children and its medical management is sometimes insufficient. It is accessible to neuroaxial or peripheral techniques of regional anesthesia if it is limited to an area accessible to one of those techniques and no contraindications (e.g., thrombopenia) are present. Complex regional pain syndrome 1 is not rare in children and adolescents but it is often undiagnosed. Regional anesthesia may contribute to the treatment of complex regional pain syndrome 1, mainly in case of recurrence, because it provides rapid effective analgesia and allows rapid implementation of intensive physiotherapy. These techniques have also shown interest in the phantom limb pain after limb amputation, but remain controversial for erythromelalgia pain or chronic abdominopelvic pain. Finally, the treatment of post-dural puncture headache due to cerebrospinal fluid leak can be treated by performing an epidural injection of patient's blood, called "blood patch". Last but not least, the management of children with chronic pain should be multidisciplinary (pediatrician, physiotherapist, psychologist, surgeon, anesthesiologist) to support the child and his problem in its globality.
Published: 2013
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44. Accompagnement à la prescription des examens complémentaires en réanimation : impact sur l'incidence des prescriptions et les coûts. [Accompanying the prescription of additional tests in intensive care: impact on incidence of prescriptions and costs]

Author: Le Maguet, P., Tanguy, Michèle, Pilon, C., Asehnoune, Karim, Mimoz, O., Lasocki, Sigismond, Gaillard, T., Morcet, Jeff, Seguin, Philippe, Mallédant, Yannick, Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Service d'Anesthésie-Réanimation [CHU Limoges], CHU Limoges, Pôle d'Anesthésie Réanimation, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Unité de Biométrie, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-Hôpital Pontchaillou, and Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2013
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45. Étude de la réponse induite par le lipopolysaccharide et l'adrénalineadrénaline dans un modèle de co-culture hépatocytes - macrophages humains. [Study of the response induced by lipopolysaccharide and adrenaline in a hepatocyte - human macrophage co-culture model]

Author: Nesseler, Nicolas, Launay, Y., Frénel, Jean-Vincent, Lebouvier, T., Seguin, Philippe, Mallédant, Yannick, Aninat, Caroline, Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Hôpital Pontchaillou-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)
Subjects: [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, ComputingMilieux_MISCELLANEOUS
Abstract: National audience
Published: 2013
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46. Apport de l'analyse informatisée des signaux cardio-respiratoires dans le diagnostic de douleur aiguë chez le nouveau-né prématuré. [Contribution of the computerized analysis of cardiorespiratory signals in the diagnosis of acute pain in premature newborns]

Author: Nardi, Nicolas, Beuchée, Alain, Hernández, Alfredo, Pladys, Patrick, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Rennes (UR)-Hôpital Pontchaillou
Subjects: [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.IB]Life Sciences [q-bio]/Bioengineering, ComputingMilieux_MISCELLANEOUS
Abstract: National audience
Published: 2013
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47. Carcinome adénoïde kystique trachéal traité par reconstruction complète de la carène sous ECMO : à propos d'un cas. [Tracheal adenoid cystic carcinoma treated by complete carinal reconstruction with the help of an ECMO: about a case]

Author: Rouzé, Simon, Flécher, E., De Latour, B., Meunier, C., Sellin, M., Lena, H., Verhoye, Jean-Philippe, Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], CHU Pontchaillou [Rennes], Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes], Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Service de pneumologie [Rennes] = Pneumology [Rennes], and Université de Rennes (UR)-Hôpital Pontchaillou
Subjects: Trachée, Cylindrome, [SDV.IB]Life Sciences [q-bio]/Bioengineering, [SDV.CAN]Life Sciences [q-bio]/Cancer, respiratory system, Adénoïde, ECMO, Kystique, Carène
Abstract: National audience; Primitive tumors of the trachea are rare, accounting for 0.1% of the airway tumors. Cystic adenoid carcinoma (or cylindroma) represents the second most frequent type of tracheal cancers. Histologically speaking, this tumor type is divided in three patterns: cribriform, tubular and solid; it presents a slow growth, perineural invasion and potential local recurrence and metastasis. We presented herein the case of a 56-year-old female suffering from a cystic adenoid carcinoma of the low trachea. She has been treated by carinal resection with negative airway margin and complete reconstruction, with the help of an extra corporeal membrane oxygenation (ECMO).
Published: 2013
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48. Low doses of fludrocortisone and hydrocortisone, alone or in combination, on vascular responsiveness to phenylephrine in healthy volunteers

Author: Laviolle, Bruno, Donal, Erwan, Le Maguet, Pascale, Lainé, Fabrice, Bellissant, Eric, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Pharmacologie [Rennes], CHU Pontchaillou [Rennes], Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CIC-IT Rennes, Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie réanimation chirurgicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Rennes (UR)-Hôpital Pontchaillou
Subjects: Adult, Male, MESH: Phenylephrine, MESH: Drug Interactions, MESH: Shock, Septic, Anti-Inflammatory Agents, Administration, Oral, Blood Pressure, MESH: Cross-Over Studies, MESH: Dose-Response Relationship, Drug, Phenylephrine, Young Adult, MESH: Vasoconstrictor Agents, Double-Blind Method, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [INFO.INFO-TS]Computer Science [cs]/Signal and Image Processing, Heart Rate, Humans, Vasoconstrictor Agents, Drug Interactions, MESH: Double-Blind Method, MESH: Fludrocortisone, hydrocortisone, MESH: Heart Rate, Infusions, Intravenous, MESH: Infusions, Intravenous, fludrocortisone, MESH: Drug Combinations, Cross-Over Studies, haemodynamics, MESH: Humans, Dose-Response Relationship, Drug, glucocorticoids, MESH: Adult, MESH: Blood Pressure, Shock, Septic, MESH: Injections, Intravenous, MESH: Hydrocortisone, MESH: Male, Drug Combinations, Pharmacodynamics, MESH: Young Adult, MESH: Anti-Inflammatory Agents, Injections, Intravenous, MESH: Administration, Oral, mineralocorticoids, [SDV.IB]Life Sciences [q-bio]/Bioengineering, [SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing
Abstract: International audience; AIMS: A single administration of hydrocortisone has been shown to enhance the pressor response to phenylephrine in healthy volunteers and to norepinephrine in septic shock patients. Similar data do not exist for fludrocortisone. Since there continues to be disagreement about the utility of fludrocortisone in septic shock, we assessed the effects of a single administration of low doses of hydrocortisone (50 mg intravenously) and fludrocortisone (50 μg orally), given either alone or in combination, on phenylephrine mean arterial pressure and cardiac systolic and diastolic function dose-response relationships in 12 healthy male volunteers with hypo-aldosteronism induced by intravenous sodium loading. METHODS: This was a placebo-controlled, randomized, double-blind, crossover study performed according to a 2 × 2 factorial design. Subjects received first a 2000 ml infusion of NaCl 0.9% during 2 h. Then fludrocortisone 50 μg (or its placebo) was administered orally and hydrocortisone 50 mg (or its placebo) was injected intravenously. At 1.5 h after treatment administration, incremental doses of phenylephrine were infused (from 0.01 to 3 μg kg(-1) min(-1)), each dose being infused during 5 min. RESULTS: Both fludrocortisone (P < 0.001) and hydrocortisone (P = 0.002) induced a significant decrease in pressor response to phenylephrine, their effects being additive (fludrocortisone × hydrocortisone interaction, P = 0.792). The two drugs did not induce any detectable cardiac effect. CONCLUSIONS: Single administrations of fludrocortisone and hydrocortisone decreased the pressor response to phenylephrine in healthy volunteers with hypo-aldosteronism. These similar effects of hydrocortisone and fludrocortisone probably express a rapid non-genomic vasodilating effect of the two steroids in the context of acute volume loading.
Published: 2013
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49. Simple bedside clinical evaluation versus established scores in the estimation of operative risk in valve replacement for severe aortic stenosis

Author: M. Laurent, Bertrand Feit, Erwan Flecher, Maxime Fournet, Erwan Donal, Alain Leguerrier, Xavier Beneux, Michel Sellin, Emmanuel Oger, Christophe Thebault, Sophie Le Reveillé, Yves Biron, Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Pharmacologie [Rennes], CIC-IT Rennes, Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Pontchaillou-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)
Subjects: Male, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Severity of Illness Index, 0302 clinical medicine, Valve replacement, Aortic valve replacement, Risk Factors, Positive predicative value, Operative risk assessment, 80 and over, 030212 general & internal medicine, Hospital Mortality, Prospective Studies, Aged, 80 and over, Heart Valve Prosthesis Implantation, Observer Variation, Ejection fraction, Operative risk, Age Factors, General Medicine, Middle Aged, 3. Good health, Cardiac surgery, Treatment Outcome, Aortic valve stenosis, Predictive value of tests, Creatinine, Cardiology, Remplacement valvulaire aortique, Biological Markers, Female, Cardiology and Cardiovascular Medicine, Operative mortality, Adult, medicine.medical_specialty, Évaluation du risque opératoire, Risk Assessment, Decision Support Techniques, 03 medical and health sciences, Young Adult, Risque opératoire, Predictive Value of Tests, Internal medicine, medicine, Humans, Aged, Chi-Square Distribution, business.industry, Reproducibility of Results, Stroke Volume, Aortic Valve Stenosis, medicine.disease, Mortalité opératoire, Surgery, Stenosis, Logistic Models, business, Biomarkers
Abstract: International audience; BACKGROUND: The operative risk of cardiac surgery is ascertained preoperatively on the basis of scores validated in multinational studies. However, the value they add to a simple bedside clinical evaluation (CE) remains controversial. AIMS: To compare operative mortality (defined as death from all causes before the 31st postoperative day) predicted by CE with that predicted by additive and logistic EuroSCOREs, EuroSCORE II and Society of Thoracic Surgeons (STS), Ambler and age-creatinine-ejection fraction (ACEF) scores in patients undergoing aortic valve replacement (AVR) for severe aortic stenosis. METHODS: Overall, 314 consecutive patients were included who underwent AVR between October 2009 and November 2011 (22% with coronary artery bypass graft); mean age 73.4 ± 9.7 years (29% aged\textgreater80 years). Based on CE, patients were divided into four predefined groups of increasing estimated mortality risk: I ≤ 3.9%; II 4-6.9%; III 7-9.9%; IV ≥ 10%. The positive and negative predictive values of the six scores and CE were compared. RESULTS: The observed overall operative mortality was 5.7%. The distribution of the four predicted mortality groups by each score was highly variable. The positive predictive value, calculated for the 64 patients classified at highest risk by CE (groups III or IV) or each score, was 17.2% for EuroSCORE II, 14.1% for CE and STS scores, 10.9% for additive and logistic EuroSCOREs, 10.6% for ACEF and 10.2% for Ambler. The positive predictive value of each score in the low-risk groups (I and II) ranged from 2.8% to 4.4%. CONCLUSION: A simple bedside CE appears as reliable as the various established scores for predicting operative risk in patients undergoing surgical aortic valve replacement. The development and validation of more comprehensive risk stratification tools, including risk factors thus far neglected, seems warranted.
Published: 2013
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50. Effects of etomidate on complications related to intubation and on mortality in septic shock patients treated with hydrocortisone: a propensity score analysis

Author: Julie Carr, Gerald Chanques, Antoine Roquilly, Moussa Cisse, Noémie Clavieras, Boris Jung, Karim Asehnoune, Stephanie Nougaret, Samir Jaber, Nicolas Molinari, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service de Soins Intensifs et Anesthésie-Réanimation, Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service d'anesthésie réanimation chirurgicale [Rennes], Université de Rennes (UR)-Hôpital Pontchaillou, Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, and BMC, Ed.
Subjects: medicine.medical_specialty, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], medicine.drug_class, medicine.medical_treatment, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Etomidate, medicine, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Intubation, 030212 general & internal medicine, Hydrocortisone, Septic shock, business.industry, Incidence (epidemiology), 030208 emergency & critical care medicine, medicine.disease, 3. Good health, Shock (circulatory), Emergency medicine, Propensity score matching, Corticosteroid, medicine.symptom, business, medicine.drug
Abstract: International audience; ABSTRACT: INTRODUCTION: Endotracheal intubation in the ICU is associated with a high incidence of complications. Etomidate use is debated in septic shock because it increases the risk of critical illness-related corticosteroid insufficiency, which may impact outcome. We hypothesized that hydrocortisone, administered in all septic shock cases in our ICU, may counteract some negative effects of etomidate.The aim of our study was to compare septic shock patients who received etomidate versus another induction drug both for short-term safety and for long-term outcomes. METHODS: A single-center observational study was carried out in septic shock patients, treated with hydrocortisone and intubated within the first 48 hours of septic shock. Co-primary end points were life-threatening complications incidence occurring within the first hour after intubation and mortality during the ICU stay. Statistical analyses included unmatched and matched cohorts using a propensity score analysis. P < 0.05 was considered significant. RESULTS: Sixty patients in the etomidate cohort and 42 patients in the non-etomidate cohort were included. Critical illness-related corticosteroid insufficiency was 79% in the etomidate cohort and 52% in the non-etomidate cohort (P = 0.01). After intubation, life-threatening complications occurred in 36% of the patients whatever the cohort. After adjustment with propensity score analysis, etomidate was a protective factor for death in the ICU both in unmatched (hazard ratio, 0.33 (0.15 to 0.75); P < 0.01)) and matched cohorts (hazard ratio, 0.33 (0.112 to 0.988); P = 0.04). CONCLUSION: In septic shock patients treated with hydrocortisone, etomidate did not decrease life-threatening complications following intubation, but when associated with hydrocortisone it also did not impair outcome.
Published: 2012
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