Author: "Thomas, Geeraerts" - Searchworks@Jio Institute Digital Library Search Results

Your search keyword '"Thomas, Geeraerts"' showing total 234 results

Start Over Author "Thomas, Geeraerts"

234 results on '"Thomas, Geeraerts"'

1. Welcome to the operating theatre! Introductory bootcamp in operating theatre specialities for medical students

Author: Etienne Buscail, Manon Bolzinger, Jason Shourick, Marie Laure Lier, Phillipe Sautier, Magali Delhoste, Fabrice Muscari, Nicolas Carrère, Charlotte Maulat, Yoann Dalmas, Pierre Brinas, Thomas Prudhomme, Cyril Podio, Charles-Henri Houze-Cerfon, Odile Rauzy, Thomas Geeraerts, and Olivier Abbo
Subjects: Undergraduate Medical Education, Surgical Education, Anaesthesia Education, Medical Students, Career, Stereotype, Special aspects of education, LC8-6691, Medicine
Abstract: Abstract Introduction Since the early 2000's, the appeal of certain operating room specialties has decreasedamong medical school graduate students. The recent reform of the second and third cycles of medical studies in France provides an opportunity to set up teaching programs around operating room specialties. We have organised a teaching unit which is part of the final year of medical studies. The main objectives are: (1) to examine whether a boot camp can modify students’ opinions and preconceived assumptions about a surgical and/or anaesthetist career (2) to determine whether these changes in perception, have an impact on students' interest in pursuing a surgical/anaesthetic career compared with the current situation. Materials and methods The “working in the operating theatre” boot camp (UETB) took place after the written exams of the sixth year of medical school, before students choose their future specialty for residency. This program included practical workshops, readings and time for exchanges surgeons and anaesthetists. At the beginning and at the end of the UETB, feedback forms were collected. Results The cohort included 59 students from the Toulouse medical school, academic year 2023–2024. After attending the UETB, there was a significant qualitative improvement in interest in a surgical and intensive care-anaesthesia career. Feedback on how the UETB influenced the choice of a future specialty was very positive, with statistically significant qualitive improvement., Additionally, the students’ perception of a work-life quality as a surgeon and/or anaesthetist improved significantly. Conclusion The outcome of this study makes a strong case for integrating additional exposure to the various surgical subspecialties into the graduate medical curriculum in France. By helping to dispel misperceptions of “a surgical/anaesthetist career” early on, opportunities such as the UETB program may enable addressing the attrition rate observed among surgical and anaesthetic residency applications.
Published: 2024
Full Text: View/download PDF

2. The Effects of Antioxidant Cocktail on Ophthalmological Changes Induced by a 60-Day Head-Down Bed Rest in a Randomized Trial

Author: Marc Kermorgant, Fanny Varenne, Anne Pavy-Le Traon, Thomas Geeraerts, Lisa Barioulet, Pierre Fournié, Rebecca Billette de Villemeur, Marie-Pierre Bareille, Arnaud Beck, Adrianos Golemis, Inês Antunes, Guillemette Gauquelin-Koch, Vincent Soler, and Jean-Claude Quintyn
Subjects: optical coherence tomography, optic nerve sheath diameter, intraocular pressure, head-down bed rest, countermeasure, microgravity, Science
Abstract: Neuro-ophthalmological changes have been reported after prolonged exposure to microgravity; however, the pathophysiology remains unclear. Furthermore, several countermeasures have been suggested to counteract the side effects of microgravity. The objectives of the present study were twofold: (1) to assess the neuro-ophthalmological impact of 60 days of head-down bed rest (HDBR) and (2) to determine the potential effects of an antioxidant cocktail. In this case, 20 healthy male subjects completed a 60-day HDBR and were randomly allocated into two groups: a control condition without an antioxidant cocktail (CON) and a condition with an antioxidant cocktail (NUT). The retinal nerve fibre layer thickness (RNFLT) and central retinal thickness (CRT) were assessed with spectral domain optical coherence tomography. The optic nerve sheath diameter (ONSD) was measured by ocular ultrasonography and used to assess indirect changes in the intracranial pressure (ICP). The intraocular pressure (IOP) was assessed by Goldmann applanation tonometry. The CRT tended to be reduced after HDBR. The ONSD was increased at the end and after HDBR. The IOP tended to decrease after HDBR. Finally, the antioxidant cocktail had minor impacts on the ophthalmological changes induced by HDBR. It is worth noting that two participants presented peripapillary edema.
Published: 2024
Full Text: View/download PDF

3. Postoperative outcomes after total sevoflurane inhalation sedation using a disposable delivery system (Sedaconda-ACD) in cardiac surgery

Author: François Labaste, Paul Cauquil, Magda Lestarquit, Pascale Sanchez-Verlaan, Abdulrahman Aljuayli, Bertrand Marcheix, Thomas Geeraerts, Fabrice Ferre, Fanny Vardon-Bounes, and Vincent Minville
Subjects: sevoflurane, cardiovascular surgery, troponin, Sedaconda, cardiac surgery, Medicine (General), R5-920
Abstract: IntroductionThe COVID-19 pandemic prompted our team to develop new solutions for performing cardiac surgery without intravenous anesthetics due to a shortage of these drugs. We utilized an anesthetic conserving device (Sedaconda-ACD) to administer total inhaled anesthesia because specific vaporizers were unavailable for administering inhaled agents during cardiopulmonary bypass (CPB) in our center. We documented our experience and postoperative cardiovascular outcomes. The primary outcome was the peak level of troponin, with secondary outcomes encompassing other cardiovascular complications.Material and methodsA single-center retrospective study was conducted. We performed a multivariate analysis with a propensity score. This investigation took place at a large university referral center.ParticipantsAdult patients (age ≥ 18) who underwent elective cardiac surgery with CPB between June 2020 to March 2021.InterventionDuring the inclusion period, two anesthesia protocols for the maintenance of anesthesia coexisted—total inhaled anesthesia with Sedaconda-ACD and our classic protocol with intravenous drugs during and after CPB.Primary endpointTroponin peak level recorded after surgery (highest level recorded within 48 h following the surgery).ResultsOut of the 654 included patients, 454 were analyzed after matching (intravenous group = 297 and inhaled group = 157). No significant difference was found between the groups in postoperative troponin peak levels (723 ng/l vs. 993 ng/l–p = 0.2). Total inhaled anesthesia was associated with a decreased requirement for inotropic medications (OR = 0.53, 95% CI 0.29–0.99, p = 0.04).ConclusionIn our cohort, the Sedaconda-ACD device enabled us to achieve anesthesia without intravenous agents, and we did not observe any increase in postoperative complications. Total inhaled anesthesia with sevoflurane was not associated with a lower incidence of myocardial injury assessed by the postoperative troponin peak level. However, in our cohort, the use of inotropic drugs was lower.
Published: 2024
Full Text: View/download PDF

4. Epidemiology and outcome predictors in 450 patients with hanging-induced cardiac arrest: a retrospective study

Author: Marie Salvetti, Guillaume Schnell, Nicolas Pichon, Maleka Schenck, Pierrick Cronier, Sebastien Perbet, Jean-Baptiste Lascarrou, Christophe Guitton, Olivier Lesieur, Laurent Argaud, Gwenhael Colin, Bernard Cholley, Jean-Pierre Quenot, Hamid Merdji, Thomas Geeraerts, Michael Piagnerelli, Gwenaelle Jacq, Marine Paul, Jonathan Chelly, Louise de Charentenay, Nicolas Deye, Marc Danguy des Déserts, Guillaume Thiery, Marc Simon, Vincent Das, Frederic Jacobs, Charles Cerf, Julien Mayaux, Pascal Beuret, Abdelkader Ouchenir, Antoine Lafarge, Bertrand Sauneuf, Cedric Daubin, Alain Cariou, Stein Silva, and Stephane Legriel
Subjects: near-hanging, intensive care unit, coma/therapy, outcome, cardiopulmonary resuscitation, Neurology. Diseases of the nervous system, RC346-429
Abstract: BackgroundCardiac arrest is the most life-threatening complication of attempted suicide by hanging. However, data are scarce on its characteristics and outcome predictors.MethodsThis retrospective observational multicentre study in 31 hospitals included consecutive adults admitted after cardiac arrest induced by suicidal hanging. Factors associated with in-hospital mortality were identified by multivariate logistic regression with multiple imputations for missing data and adjusted to the temporal trends over the study period.ResultsOf 450 patients (350 men, median age, 43 [34–52] years), 305 (68%) had a psychiatric history, and 31 (6.9%) attempted hanging while hospitalized. The median time from unhanging to cardiopulmonary resuscitation was 0 [0–5] min, and the median time to return of spontaneous circulation (ROSC) was 20 [10–30] min. Seventy-nine (18%) patients survived to hospital discharge. Three variables were independently associated with higher in-hospital mortality: time from collapse or unhanging to ROSC>20 min (odds ratio [OR], 4.71; 95% confidence intervals [95%CIs], 2.02–10.96; p = 0.0004); glycaemia >1.4 g/L at admission (OR, 6.38; 95%CI, 2.60–15.66; p < 0.0001); and lactate >3.5 mmol/L at admission (OR, 6.08; 95%CI, 1.71–21.06; p = 0.005). A Glasgow Coma Scale (GCS) score of >5 at admission was associated with lower in-hospital mortality (OR, 0.009; 95%CI, 0.02–0.37; p = 0.0009).ConclusionIn patients with hanging-induced cardiac arrest, time from collapse or unhanging to return of spontaneous circulation, glycaemia, arterial lactate, and coma depth at admission were independently associated with survival to hospital discharge. Knowledge of these risk factors may help guide treatment decisions in these patients at high risk of hospital mortality.
Published: 2023
Full Text: View/download PDF

5. Is it valid to assess an individual’s performance in team training simulation when the supporting team are confederates? A controlled and randomized clinical trial

Author: Jérémie Traoré, Frédéric Balen, Thomas Geeraerts, Sandrine Charpentier, Xavier Dubucs, and Charles-Henri Houzé-Cerfon
Subjects: Health education, Simulation training, Interprofessional education, Crisis resource management, Emergency medicine, Special aspects of education, LC8-6691, Medicine
Abstract: Background During simulation training, the confederate is a member of the pedagogical team. Its role is to facilitate the interaction between participants and the environment, and is thought to increase realism and immersion. Its influence on participants' performance in full-scale simulation remains however unknown. The purpose of this study was to observe the effect of the presence of confederates on the participants’ performance during full-scale simulation of crisis medical situations. Methods This was a prospective, randomized study comparing 2 parallel groups. Participants were emergency medicine residents engaging in a simulation session, with or without confederates. Participants were then evaluated on their Crisis Resource Management performance (CRM). The overall performance score on the Ottawa Global Rating Scale was assessed as primary outcome and the 5 non-technical CRM skills as secondary outcomes. Results A total of 63 simulation sessions, including 63 residents, were included for statistical analysis (n = 32 for Control group and 31 for Confederate group). The mean Overall Performance score was 3.9 ± 0.8 in the Control group and 4.0 ± 1.1 in the Confederate group, 95% confidence interval of the difference [-0.6; 0.4], p = 0.60. No significant differences between the two groups were observed on each CRM items (leadership, situational awareness, communication, problem solving, resource utilization) Conclusion In this randomized and controlled study, the presence of confederates during full-scale simulated practice of crisis medical situations does not seem to influence the CRM skills performance of Emergency medicine residents. Trial registration This study does not need to be registered on Clintrial as it does not report a health care intervention on human participants.
Published: 2022
Full Text: View/download PDF

6. Effect of an individualized versus standard blood pressure management during mechanical thrombectomy for anterior ischemic stroke: the DETERMINE randomized controlled trial

Author: Benjamin Maïer, Benjamin Gory, Russell Chabanne, Benoît Tavernier, Baptiste Balanca, Gérard Audibert, Laurie-Anne Thion, Morgan Le Guen, Thomas Geeraerts, Lionel Calviere, Vincent Degos, Bertrand Lapergue, Sebastien Richard, Azeddine Djarallah, Ornellia Mophawe, Perrine Boursin, Chloé Le Cossec, Raphael Blanc, Michel Piotin, Mikael Mazighi, Etienne Gayat, and on behalf of the DETERMINE Investigators
Subjects: Stroke, Blood pressure, Thrombectomy, Disability, Mean arterial pressure, Circulation, Medicine (General), R5-920
Abstract: Abstract Background Hypotension and blood pressure (BP) variability during endovascular therapy (EVT) for acute ischemic stroke (AIS) due to an anterior large vessel occlusion (LVO) is associated with worse outcomes. However, the optimal BP threshold during EVT is still unknown given the lack of randomized controlled evidence. We designed the DETERMINE trial to assess whether an individualized BP management during EVT could achieve better functional outcomes compared to a standard BP management. Methods The DETERMINE trial is a multicenter, prospective, randomized, controlled, open-label, blinded endpoint clinical trial (PROBE design). AIS patients with a proximal anterior LVO are randomly assigned, in a 1:1 ratio, to an experimental arm in which mean arterial pressure (MAP) is maintained within 10% of the first MAP measured before EVT, or a control arm in which systolic BP (SBP) is maintained within 140–180 mm Hg until reperfusion is achieved or artery closure in case of EVT failure. The primary outcome is the rate of favorable functional outcomes, defined by a modified Rankin Scale (mRS) between 0 and 2 at 90 days. Secondary outcomes include excellent outcome and ordinal analysis of the mRS at 90 days, early neurological improvement at 24 h (National Institutes of Health Stroke Scale), final infarct volume, symptomatic intracranial hemorrhage rates, and all-cause mortality at 90 days. Overall, 432 patients will be included. Discussion DETERMINE will assess the clinical relevance of an individualized BP management before reperfusion compared to the one size fits all approach currently recommended by international guidelines. Trial registration ClinicalTrials.gov , NCT04352296. Registered on 20th April 2020.
Published: 2022
Full Text: View/download PDF

7. Is there a benefit for anesthesiologists of adding difficult airway scenarios for learning fiberoptic intubation skills using virtual reality training? A randomized controlled study.

Author: Loic Cailleau, Thomas Geeraerts, Vincent Minville, Olivier Fourcade, Thomas Fernandez, Jean Etienne Bazin, Linden Baxter, Vassilis Athanassoglou, Henry Jefferson, Anika Sud, Tim Davies, Cyprian Mendonca, Matteo Parotto, and Matt Kurrek
Subjects: Medicine, Science
Abstract: Fiberoptic intubation for a difficult airway requires significant experience. Traditionally only normal airways were available for high fidelity bronchoscopy simulators. It is not clear if training on difficult airways offers an advantage over training on normal airways. This study investigates the added value of difficult airway scenarios during virtual reality fiberoptic intubation training. A prospective multicentric randomized study was conducted 2019 to 2020, among 86 inexperienced anesthesia residents, fellows and staff. Two groups were compared: Group N (control, n = 43) first trained on a normal airway and Group D (n = 43) first trained on a normal, followed by three difficult airways. All were then tested by comparing their ORSIM® scores on 5 scenarios (1 normal and 4 difficult airways). The final evaluation ORSIM® score for the normal airway testing scenario was significantly higher for group N than group D: median score 76% (IQR 56.5-90) versus 58% (IQR 51.5-69, p = 0.0039), but there was no difference in ORSIM® scores for the difficult intubation testing scenarios. A single exposure to each of 3 different difficult airway scenarios did not lead to better fiberoptic intubation skills on previously unseen difficult airways, when compared to multiple exposures to a normal airway scenario. This finding may be due to the learning curve of approximately 5-10 exposures to a specific airway scenario required to reach proficiency.
Published: 2023
Full Text: View/download PDF

8. Perioperative Risk Assessment of Patients Using the MyRISK Digital Score Completed Before the Preanesthetic Consultation: Prospective Observational Study

Author: Fabrice Ferré, Rodolphe Laurent, Philippine Furelau, Emmanuel Doumard, Anne Ferrier, Laetitia Bosch, Cyndie Ba, Rémi Menut, Matt Kurrek, Thomas Geeraerts, Antoine Piau, and Vincent Minville
Subjects: Computer applications to medicine. Medical informatics, R858-859.7, Surgery, RD1-811
Abstract: BackgroundThe ongoing COVID-19 pandemic has highlighted the potential of digital health solutions to adapt the organization of care in a crisis context. ObjectiveOur aim was to describe the relationship between the MyRISK score, derived from self-reported data collected by a chatbot before the preanesthetic consultation, and the occurrence of postoperative complications. MethodsThis was a single-center prospective observational study that included 401 patients. The 16 items composing the MyRISK score were selected using the Delphi method. An algorithm was used to stratify patients with low (green), intermediate (orange), and high (red) risk. The primary end point concerned postoperative complications occurring in the first 6 months after surgery (composite criterion), collected by telephone and by consulting the electronic medical database. A logistic regression analysis was carried out to identify the explanatory variables associated with the complications. A machine learning model was trained to predict the MyRISK score using a larger data set of 1823 patients classified as green or red to reclassify individuals classified as orange as either modified green or modified red. User satisfaction and usability were assessed. ResultsOf the 389 patients analyzed for the primary end point, 16 (4.1%) experienced a postoperative complication. A red score was independently associated with postoperative complications (odds ratio 5.9, 95% CI 1.5-22.3; P=.009). A modified red score was strongly correlated with postoperative complications (odds ratio 21.8, 95% CI 2.8-171.5; P=.003) and predicted postoperative complications with high sensitivity (94%) and high negative predictive value (99%) but with low specificity (49%) and very low positive predictive value (7%; area under the receiver operating characteristic curve=0.71). Patient satisfaction numeric rating scale and system usability scale median scores were 8.0 (IQR 7.0-9.0) out of 10 and 90.0 (IQR 82.5-95.0) out of 100, respectively. ConclusionsThe MyRISK digital perioperative risk score established before the preanesthetic consultation was independently associated with the occurrence of postoperative complications. Its negative predictive strength was increased using a machine learning model to reclassify patients identified as being at intermediate risk. This reliable numerical categorization could be used to objectively refer patients with low risk to teleconsultation.
Published: 2023
Full Text: View/download PDF

9. A study of patients’ quality of life more than 5 years after trauma: a prospective follow-up

Author: Fanny Vardon-Bounes, Romain Gracia, Timothée Abaziou, Laure Crognier, Thierry Seguin, François Labaste, Thomas Geeraerts, Bernard Georges, Jean-Marie Conil, and Vincent Minville
Subjects: Quality of life, Trauma, NHP, MOS-SF36, Disability, Rehabilitation, Computer applications to medicine. Medical informatics, R858-859.7
Abstract: Abstract Background The long-term fate of severely injured patients in terms of their quality of life is not well known. Our aim was to assess the quality of life of patients who have suffered moderate to severe trauma and to identify primary factors of long-term quality of life impairment. Methods A prospective monocentric study conducted on a number of patients who were victims of moderate to severe injuries during the year 2012. Patients were selected based on an Injury Severity Score (ISS) more than or equal to 9. Quality of life was assessed by the MOS SF-36 and NHP scores as a primary evaluation criterion. The secondary evaluation criteria were the determination of the socio-economic impact on quality of life and the identification of factors associated with disability. Results Two hundred and eight patients were contacted by e-mail or telephone. Fifty-five patients participated in this study (with a participation level of 26.4%), including 78.2% men, with a median age of 46. Significant alterations in quality of life were observed with the NHP and MOS SF-36 scale, including physical and psychological components. This resulted in a major socio-economic impact as 26% of the patients could not resume their professional activities (n = 10), 20% required retraining in other lines of work, and 36.4% had a disability status. The study showed that scores ≤ 85 on the physical functioning variable of the MOS SF 36 scale was associated with disability. Conclusion More than five years after a moderate to severe injury, patients’ quality of life was significantly impacted, resulting in significant socio-economic consequences. Disability secondary to major trauma seems to be associated with a score ≤ 85 on the physical functioning dimension of the MOS SF-36 scale. This study raises the question of whether or not early rehabilitation programs should be implemented in order to limit the long-term impact of major trauma.
Published: 2021
Full Text: View/download PDF

10. Rebleeding After Aneurysmal Subarachnoid Hemorrhage in Two Centers Using Different Blood Pressure Management Strategies

Author: Lionel Calviere, Celine S. Gathier, Marie Rafiq, Inez Koopman, Vanessa Rousseau, Nicolas Raposo, Jean François Albucher, Alain Viguier, Thomas Geeraerts, Christophe Cognard, Gabriel J. E. Rinkel, Mervyn D. I. Vergouwen, and Jean-Marc Olivot
Subjects: rebleeding, intracranial aneurysm, subarachnoid hemorrhage, blood pressure, delayed cerebral ischemia, Neurology. Diseases of the nervous system, RC346-429
Abstract: BackgroundHigh systolic blood pressure (SBP) after aneurysmal subarachnoid hemorrhage (aSAH) has been associated with an increased risk of rebleeding. It remains unclear if an SBP lowering strategy before aneurysm treatment decreases this risk without increasing the risk of a delayed cerebral ischemia (DCI). Therefore, we compared the rates of in-hospital rebleeding and DCI among patients with aSAH admitted in two tertiary care centers with different SBP management strategies.MethodsRetrospective cohort study. Consecutive patients from Utrecht and Toulouse admitted within 24 h after the aSAH onset were enrolled. In Toulouse, the target SBP before aneurysm treatment was ≤140 mm Hg, while, in Utrecht, an increased SBP was only treated in extreme situations. We compared SBP levels, the incidence of rebleeding within 24 h after admission, and DCI during hospitalization.ResultsWe enrolled 373 patients in Utrecht and 149 in Toulouse. The mean SBP on admission was similar but lower in Toulouse 4 h after admission (127.3 ± 17.4 vs. 138. ± 25.7 mmHg; p < 0.0001). After a median delay of 3.7 h (IQR, 2.3–7.4) from admission, 4 patients (3%) in Toulouse vs. 29 (8%) in Utrecht experienced a rebleeding. After adjustment for Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage (PAASH) score, aneurysm size, age, and delay from ictus to admission, the HR was 0.66 (95% CI: 0.23–1.92). Incidence of DCI was 18% in Toulouse and 25% in Utrecht (adjusted OR, 0.68; 95% CI: 0.41–1.11).ConclusionOur results suggest that an intensive SBP lowering strategy between admission and aneurysm treatment does not decrease the risk of rebleeding and does not increase the risk of DCI compared to a more conservative strategy.
Published: 2022
Full Text: View/download PDF

11. Effects of Venoconstrictive Thigh Cuffs on Dry Immersion-Induced Ophthalmological Changes

Author: Marc Kermorgant, Ayria Sadegh, Thomas Geeraerts, Fanny Varenne, Jérémy Liberto, François-Philippe Roubelat, Noémie Bataille, Marie-Pierre Bareille, Arnaud Beck, Brigitte Godard, Adrianos Golemis, Nathalie Nasr, Dina N. Arvanitis, Ophélie Hélissen, Jean-Michel Senard, Anne Pavy-Le Traon, and Vincent Soler
Subjects: optical coherence tomography, optic nerve sheath diameter, intraocular pressure, intracranial pressure, dry immersion, microgravity, Physiology, QP1-981
Abstract: Neuro-ophthalmological changes named spaceflight associated neuro-ocular syndrome (SANS) reported after spaceflights are important medical issues. Dry immersion (DI), an analog to microgravity, rapidly induces a centralization of body fluids, immobilization, and hypokinesia similar to that observed during spaceflight. The main objectives of the present study were 2-fold: (1) to assess the neuro-ophthalmological impact during 5 days of DI and (2) to determine the effects of venoconstrictive thigh cuffs (VTC), used as a countermeasure to limit headward fluid shift, on DI-induced ophthalmological adaptations. Eighteen healthy male subjects underwent 5 days of DI with or without VTC countermeasures. The subjects were randomly assigned into two groups of 9: a control and cuffs group. Retinal and optic nerve thickness were assessed with spectral-domain optical coherence tomography (OCT). Optic nerve sheath diameter (ONSD) was measured by ocular ultrasonography and used to assess indirect changes in intracranial pressure (ICP). Intraocular pressure (IOP) was assessed by applanation tonometry. A higher thickness of the retinal nerve fiber layer (RNFL) in the temporal quadrant was observed after DI. ONSD increased significantly during DI and remained higher during the recovery phase. IOP did not significantly change during and after DI. VTC tended to limit the ONSD enlargement but not the higher thickness of an RNFL induced by DI. These findings suggest that 5 days of DI induced significant ophthalmological changes. VTC were found to dampen the ONSD enlargement induced by DI.
Published: 2021
Full Text: View/download PDF

12. Short term effects of simulation training on stress, anxiety and burnout in critical care health professionals: before and after study

Author: Sébastien Couarraze, Michèle Saint Jean, Guillaume Decormeille, Charles Henri Houze Cerfon, Vincent Minville, Olivier Fourcade, and Thomas Geeraerts
Subjects: Nursing (miscellaneous), Modeling and Simulation, Education
Published: 2023
Full Text: View/download PDF

13. Systematic Screening for Deep Vein Thrombosis in Critically Ill Inpatients With COVID-19: Impact on the Incidence of Venous Thromboembolism

Author: François-Xavier Lapébie, Vincent Minville, Agnès Ribes, Bertrand Combis, Arthur Thery, Thomas Geeraerts, Stein Silva, Alessandra Bura-Rivière, and Fanny Vardon-Bounes
Subjects: COVID-19, venous thromboembolism, ultrasonography, deep vein thrombosis, intensive care unit, Medicine (General), R5-920
Abstract: Background: Several studies suggest an increased incidence of thrombosis in COVID-19 patients. However, evidence on how to prevent and even treat it is scarce. The aim of this study was to compare the cumulative incidence of venous thromboembolism (VTE) of two different methods for lower extremity deep vein thrombosis (LE-DVT) diagnosis: systematic vs. clinically guided complete compression venous ultrasonography (CCUS). We conducted a monocentric, prospective, open-label, non-randomized study. All consecutive patients admitted in three intensive care units (ICUs) of University Hospital of Toulouse for COVID-19 pneumonia were included: one performed systematic screening for LE-DVT, the others did not. The primary outcome was the 21-day cumulative incidence of VTE. The secondary end points were the 21-day cumulative incidences of major bleeding and death.Results: Among the 78 patients included, 27 (34.6%) underwent systematic screening for DVT 7 ± 2 days after ICU admission. Thirty-two patients (41.0%) were diagnosed with VTE, with a 21-day cumulative incidence of 42.3% (95% CI, 31.4–55.2), without difference between screened and non-screened patients (hazard ratio 1.45, 95% CI, 0.72–2.93). In the screened group, the frequency of isolated DVT was higher (25.9 vs. 5.9%, p-value = 0.027), but the frequency of pulmonary embolism was not reduced (25.9 vs. 29.4%, p-value = 0.745). The 21-day cumulative incidences of major bleeding and death were 9.6% (95% CI, 4.7–19.2) and 10.3% (95% CI, 5.0–20.8), respectively, without difference between the two groups.Conclusions: A systematic screening for DVT in patients hospitalized in ICU was not associated with a higher diagnosis of VTE or a reduced diagnosis of PE.
Published: 2021
Full Text: View/download PDF

14. Comparison of strategies for monitoring and treating patients at the early phase of severe traumatic brain injury: the multicentre randomised controlled OXY-TC trial study protocol

Author: Nicolas Bruder, Thomas Geeraerts, Jean Luc Bosson, Claire Dahyot-fizelier, Pierre Bouzat, Jean-François Payen, Laurent Gergelé, Gérard Audibert, Louis Puybasset, Marion Richard, Gilles Francony, Emmanuel L Barbier, Bernard Vigue, and Kristina Skaare
Subjects: Medicine
Abstract: Introduction Intracranial hypertension is considered as an independent risk factor of mortality and neurological disabilities after severe traumatic brain injury (TBI). However, clinical studies have demonstrated that episodes of brain ischaemia/hypoxia are common despite normalisation of intracranial pressure (ICP). This study assesses the impact on neurological outcome of guiding therapeutic strategies based on the monitoring of both brain tissue oxygenation pressure (PbtO2) and ICP during the first 5 days following severe TBI.Methods and analysis Multicentre, open-labelled, randomised controlled superiority trial with two parallel groups in 300 patients with severe TBI. Intracerebral monitoring must be in place within the first 16 hours post-trauma. Patients are randomly assigned to the ICP group or to the ICP + PbtO2 group. The ICP group is managed according to the international guidelines to maintain ICP≤20 mm Hg. The ICP + PbtO2 group is managed to maintain PbtO2 ≥20 mm Hg in addition to the conventional optimisation of ICP. The primary outcome measure is the neurological status at 6 months as assessed using the extended Glasgow Outcome Scale. Secondary outcome measures include quality-of-life assessment, mortality rate, therapeutic intensity and incidence of critical events during the first 5 days. Analysis will be performed according to the intention-to-treat principle and full statistical analysis plan developed prior to database freeze.Ethics and dissemination This study has been approved by the Institutional Review Board of Sud-Est V (14-CHUG-48) and from the National Agency for Medicines and Health Products Safety (Agence Nationale de Sécurité du Médicament et des produits de santé) (141 435B-31). Results will be presented at scientific meetings and published in peer-reviewed publications.The study was registered with ClinTrials NCT02754063 on 28 April 2016 (pre-results).
Published: 2020
Full Text: View/download PDF

15. Diagnostic performance of abdominal point of care ultrasound performed by an emergency physician in acute right iliac fossa pain

Author: Jean-Eudes Bourcier, Emeric Gallard, Jean-Philippe Redonnet, Magali Majourau, Dominique Deshaie, Jean-Marie Bourgeois, Didier Garnier, and Thomas Geeraerts
Subjects: Bedside ultrasound, Abdominal pain, Appendicitis, Diagnostic methods, Medical physics. Medical radiology. Nuclear medicine, R895-920
Abstract: Abstract Background Right iliac fossa abdominal pain is a common reason for emergency ward admissions, its etiology is difficult to diagnose. It can be facilitated by an imaging examination, such as a Computerized Tomography scan which exposes the patient to ionizing radiation and implies delays. A bedside ultrasound performed by emergency physicians could avoid these issues. The aim of our study was to assess the performance of ultrasound carried out at the patient’s bedside by an emergency physician compared with a clinical-laboratory examination for the diagnosis of a surgical pathology in right iliac fossa pain. Methods This is a single-center prospective cohort study conducted in an Emergency Department receiving 19,000 patients per year. All patients presenting pain in the right iliac fossa were included by four (out of ten) emergency physicians certified in an ultrasound examination. A full grid pattern scan ultrasound of the abdominal cavity with analysis of the right iliac fossa was performed. The primary outcome was to compare the diagnosis performance of bedside ultrasound and clinical-laboratory examination to detect a surgical pathology. Two emergency physicians who did not participate in the study made the final diagnosis (i.e., surgical or non-surgical pathology) by reviewing the entire medical chart of each patient. Results From January 2011 to July 2013, 158 patients with a median age of 17 [13–32] years were analyzed. The diagnosed cases were: appendicitis (53), non-specific abdominal pain (48), lymphadenitis (22), ileitis (11), complicated ovarian cysts (7), neoplasias (5), inflammatory or infectious colitis (5), inguinal herniations (3), bowel obstructions (2), and salpingitis (2). The accuracy of ultrasound diagnoses was 0.89 (95% CI 0.84–0.94) versus 0.70 (95% CI 0.57–0.82) for diagnoses based on clinical-laboratory examination only (p
Published: 2018
Full Text: View/download PDF

16. Use of Screen-Based Simulation in Nursing Schools in France: A National, Descriptive Study

Author: Guillaume Decormeille, Nathalie Huet, Laurent Poiroux, Jean Christophe Servotte, Charles Henri Houze Cerfon, Cynthia L. Foronda, Esther Leon Castelao, Sébastien Couarraze, and Thomas Geeraerts
Subjects: Nursing (miscellaneous), Modeling and Simulation, Education
Published: 2022
Full Text: View/download PDF

17. Association between continuous hyperosmolar therapy and survival in patients with traumatic brain injury – a multicentre prospective cohort study and systematic review

Author: Karim Asehnoune, Sigismond Lasocki, Philippe Seguin, Thomas Geeraerts, Pierre François Perrigault, Claire Dahyot-Fizelier, Catherine Paugam Burtz, Fabrice Cook, Dominique Demeure dit latte, Raphael Cinotti, Pierre Joachim Mahe, Camille Fortuit, Romain Pirracchio, Fanny Feuillet, Véronique Sébille, Antoine Roquilly, For the ATLANREA group, and For the COBI group
Subjects: Trauma, Traumatic brain injury, Intracranial hypertension, Brain oedema, Hyperosmolar therapy, Saline solution, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Intracranial hypertension (ICH) is a major cause of death after traumatic brain injury (TBI). Continuous hyperosmolar therapy (CHT) has been proposed for the treatment of ICH, but its effectiveness is controversial. We compared the mortality and outcomes in patients with TBI with ICH treated or not with CHT. Methods We included patients with TBI (Glasgow Coma Scale ≤ 12 and trauma-associated lesion on brain computed tomography (CT) scan) from the databases of the prospective multicentre trials Corti-TC, BI-VILI and ATLANREA. CHT consisted of an intravenous infusion of NaCl 20% for 24 hours or more. The primary outcome was the risk of survival at day 90, adjusted for predefined covariates and baseline differences, allowing us to reduce the bias resulting from confounding factors in observational studies. A systematic review was conducted including studies published from 1966 to December 2016. Results Among the 1086 included patients, 545 (51.7%) developed ICH (143 treated and 402 not treated with CHT). In patients with ICH, the relative risk of survival at day 90 with CHT was 1.43 (95% CI, 0.99–2.06, p = 0.05). The adjusted hazard ratio for survival was 1.74 (95% CI, 1.36–2.23, p
Published: 2017
Full Text: View/download PDF

18. Management of Cerebral Venous Thrombosis Due to Adenoviral COVID-19 Vaccination

Author: Adrian Scutelnic, Katarzyna Krzywicka, Joshua Mbroh, Anita van de Munckhof, Mayte Sánchez van Kammen, Diana Aguiar de Sousa, Erik Lindgren, Katarina Jood, Albrecht Günther, Sini Hiltunen, Jukka Putaala, Andreas Tiede, Frank Maier, Rolf Kern, Thorsten Bartsch, Katharina Althaus, Alfonso Ciccone, Markus Wiedmann, Mona Skjelland, Antonio Medina, Elisa Cuadrado‐Godia, Thomas Cox, Avinash Aujayeb, Nicolas Raposo, Katia Garambois, Jean‐Francois Payen, Fabrice Vuillier, Guillaume Franchineau, Serge Timsit, David Bougon, Marie‐Cécile Dubois, Audrey Tawa, Clement Tracol, Emmanuel De Maistre, Fabrice Bonneville, Caroline Vayne, Annerose Mengel, Dominik Michalski, Johann Pelz, Matthias Wittstock, Felix Bode, Julian Zimmermann, Judith Schouten, Alina Buture, Sean Murphy, Vincenzo Palma, Alberto Negro, Alexander Gutschalk, Simon Nagel, Silvia Schoenenberger, Giovanni Frisullo, Carla Zanferrari, Francesco Grillo, Fabrizio Giammello, Mar Morin Martin, Alvaro Cervera, Jim Burrow, Carlos Garcia Esperon, Beng Lim Alvin Chew, Timothy J. Kleinig, Cristina Soriano, Domenico S. Zimatore, Marco Petruzzellis, Ahmed Elkady, Miguel S. Miranda, João Fernandes, Åslög Hellström Vogel, Elias Johansson, Anemon Puthuppallil Philip, Shelagh B. Coutts, Simerpreet Bal, Brian Buck, Catherine Legault, Dylan Blacquiere, Hans D. Katzberg, Thalia S. Field, Vanessa Dizonno, Thomas Gattringer, Christian Jacobi, Annemie Devroye, Robin Lemmens, Espen Saxhaug Kristoffersen, Monica Bandettini di Poggio, Masoud Ghiasian, Theodoros Karapanayiotides, Sophie Chatterton, Miriam Wronski, Karl Ng, Robert Kahnis, Thomas Geeraerts, Peggy Reiner, Charlotte Cordonnier, Saskia Middeldorp, Marcel Levi, Eric C. M. van Gorp, Diederik van de Beek, Justine Brodard, Johanna A. Kremer Hovinga, Marieke J. H. A. Kruip, Turgut Tatlisumak, José M. Ferro, Jonathan M. Coutinho, Marcel Arnold, Sven Poli, Mirjam R. Heldner, Virology, Hematology, HUS Neurocenter, Department of Neurosciences, University of Helsinki, Neurologian yksikkö, Clinicum, Neurology, Graduate School, ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders, Vascular Medicine, ACS - Pulmonary hypertension & thrombosis, ARD - Amsterdam Reproduction and Development, ANS - Neuroinfection & -inflammation, AII - Infectious diseases, and Repositório da Universidade de Lisboa
Subjects: SINUS THROMBOSIS, Venous Thrombosis, COVID-19 Vaccines, SARS-CoV-2, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Vaccination, 3112 Neurosciences, Embòlia i trombosi cerebral, Anticoagulants, COVID-19, Immunoglobulins, Intravenous, 610 Medicine & health, Hematology, Vacunes, COVID-19 (Malaltia), 3124 Neurology and psychiatry, Adenoviridae, Neurology, SDG 3 - Good Health and Well-being, Humans, Hematologi, Neurology (clinical), Intracranial Thrombosis
Abstract: © 2022 The Authors. Annals of Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.562 This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made., Objective: Cerebral venous thrombosis (CVT) caused by vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare adverse effect of adenovirus-based severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) vaccines. In March 2021, after autoimmune pathogenesis of VITT was discovered, treatment recommendations were developed. These comprised immunomodulation, non-heparin anticoagulants, and avoidance of platelet transfusion. The aim of this study was to evaluate adherence to these recommendations and its association with mortality. Methods: We used data from an international prospective registry of patients with CVT after the adenovirus-based SARS-CoV-2 vaccination. We analyzed possible, probable, or definite VITT-CVT cases included until January 18, 2022. Immunomodulation entailed administration of intravenous immunoglobulins and/or plasmapheresis. Results: Ninety-nine patients with VITT-CVT from 71 hospitals in 17 countries were analyzed. Five of 38 (13%), 11 of 24 (46%), and 28 of 37 (76%) of the patients diagnosed in March, April, and from May onward, respectively, were treated in-line with VITT recommendations (p < 0.001). Overall, treatment according to recommendations had no statistically significant influence on mortality (14/44 [32%] vs 29/55 [52%], adjusted odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.16-1.19). However, patients who received immunomodulation had lower mortality (19/65 [29%] vs 24/34 [70%], adjusted OR = 0.19, 95% CI = 0.06-0.58). Treatment with non-heparin anticoagulants instead of heparins was not associated with lower mortality (17/51 [33%] vs 13/35 [37%], adjusted OR = 0.70, 95% CI = 0.24-2.04). Mortality was also not significantly influenced by platelet transfusion (17/27 [63%] vs 26/72 [36%], adjusted OR = 2.19, 95% CI = 0.74-6.54). Conclusions: In patients with VITT-CVT, adherence to VITT treatment recommendations improved over time. Immunomodulation seems crucial for reducing mortality of VITT-CVT. ANN NEUROL 2022;92:562-573., This research was funded by The Netherlands Organisation for Health Research and Development (ZonMw, grant number 10430072110005) and the Dr. C. J. Vaillant Foundation.
Published: 2022
Full Text: View/download PDF

19. Sedation versus general anaesthesia in endovascular therapy for anterior circulation acute ischaemic stroke: the multicentre randomised controlled AMETIS trial study protocol

Author: Samir Jaber, Emmanuel Futier, Anne-Christine Januel, Mohamed Aggour, Emmanuel Chabert, Nicolas Molinari, Nicolas Bruder, Thomas Geeraerts, Claire Dahyot-fizelier, Christophe Cognard, Mathieu Zuber, Hilde Henon, Russell Chabanne, Charlotte Fernandez-Canal, Vincent Degos, Anne-Claire Lukaszewicz, Lionel Velly, Segolene Mrozek, Pierre-François Perrigault, Benoit Tavernier, Franck Verdonk, Elodie Caumon, Aurélie Masgrau, Marc Begard, Anna Ferrier, Kevin Lagarde, Bernard Cosserant, Thibault Cammas, Julien Pascal, Florian Grimaldi, Christine Rolhion, Dominique Morand, Erwan Laroche, Camille Boissy, Romain Grobost, Antoine Brandely, Isabelle Langlade, Danielle Saurel, Laurent Vallet, Nathalie Bourgois, Xavier Moisset, Pierre Clavelou, Nicolas Vitello, Betty Jean, Abderrahim Zerroug, Ricardo Moreno, Jean Gabrillargues, Jean-François Payen, Romain Pasqualotto, Grégory Torkomian, Valentine Battisti, Lionel Bapteste, Anisoara Gemanar, Catherine Mottolese, Roxane Silve, Olivier Lavabre, Elie Thomas, Violaine Baranger, Helene Braud, Elisabeth Lenormand, David Bernstein, Marie Gilles-Baray, Chrysanthi Papagiannaki, Camille Vaisse, Michele Bertrandy, Laure Doukhan, Sophie Cataldi, Valentine Verdier, Didier Sanchez, Jean-Claude Dumont, Francois Delort, Fouad Marhar, Elsa Tardif, David Rousset, Claire Larcher, Louis Delamarre, Charlotte Martin, Diane Osinski, Francois Gaussiat, Olivier Fourcade, Jean-François Albucher, Jean-Marc Olivot, Lionel Calviere, Nicolas Raposo, Alain Viguier, Fabrice Bonneville, Philippe Tall, Caterina Michelozzi, Jean Darcourt, Elodie Parry, Sarah Surmont, Laurie Parmentier, Elsa Jozefowicz, Apolline Kazemihru, Aureli Lafanechere, Lois Henry, Clément Magand, Anaele Pregny, Marlene Bonnefoi, Francesca Rapido, Océane Garnier, Kevin Chalard, Vincent Costala, Jérome Ridolfo, Mokhtar Bouhaddjar, Bénédicte Delye, Anne-Francoise Hocquet, Julien Fendeleur, Sandra Granson, Anne Lelong, Sonia Alamowitch, and Souad Fellous
Subjects: Medicine
Abstract: Introduction Endovascular thrombectomy is the standard of care for anterior circulation acute ischaemic stroke (AIS) secondary to emergent large vessel occlusion in patients who qualify. General anaesthesia (GA) or conscious sedation (CS) is usually required to ensure patient comfort and avoid agitation and movement during thrombectomy. However, the question of whether the use of GA or CS might influence functional outcome remains debated. Indeed, conflicting results exist between observational studies with better outcomes associated with CS and small monocentric randomised controlled trials favouring GA. Therefore, we aim to evaluate the effect of CS versus GA on functional outcome and periprocedural complications in endovascular mechanical thrombectomy for anterior circulation AIS.Methods and analysis Anesthesia Management in Endovascular Therapy for Ischemic Stroke (AMETIS) trial is an investigator initiated, multicentre, prospective, randomised controlled, two-arm trial. AMETIS trial will randomise 270 patients with anterior circulation AIS in a 1:1 ratio, stratified by centre, National Institutes of Health Stroke Scale (≤15 or >15) and association of intravenous thrombolysis or not to receive either CS or GA. The primary outcome is a composite of functional independence at 3 months and absence of perioperative complication occurring by day 7 after endovascular therapy for anterior circulation AIS. Functional independence is defined as a modified Rankin Scale score of 0–2 by day 90. Perioperative complications are defined as intervention-associated arterial perforation or dissection, pneumonia or myocardial infarction or cardiogenic acute pulmonary oedema or malignant stroke evolution occurring by day 7.Ethics and dissemination The AMETIS trial was approved by an independent ethics committee. Study began in august 2017. Results will be published in an international peer-reviewed medical journal.Trial registration number NCT03229148.
Published: 2019
Full Text: View/download PDF

20. Cerebral Expression of Glial Fibrillary Acidic Protein, Ubiquitin Carboxy-Terminal Hydrolase-L1, and Matrix Metalloproteinase 9 After Traumatic Brain Injury and Secondary Brain Insults in Rats

Author: Ségolène Mrozek, Louis Delamarre, Florence Capilla, Talal Al-Saati, Olivier Fourcade, Jean-Michel Constantin, and Thomas Geeraerts
Subjects: Medicine (General), R5-920
Abstract: Glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1), and matrix metalloproteinase 9 (MMP-9) are potential biomarkers of traumatic brain injury (TBI) but also of secondary insults to the brain. The aim of this study was to describe the cerebral distribution of GFAP, UCH-L1, and MMP-9 in a rat model of diffuse TBI associated with standardized hypoxia-hypotension (HH). Adult male Sprague-Dawley rats were allocated to Sham (n = 10), TBI (n = 10), HH (n = 10), and TBI+HH (n = 10) groups. After 4 hours, brains were rapidly removed and immunostaining of GFAP, UCH-L1, and MMP-9 was performed. Areas of interest that have been described as particularly sensitive to hypoxic insults were analyzed. For GFAP, in the neocortex, immunostaining revealed a significant decrease in strong staining for HH and TBI+HH groups compared with TBI group ( P
Published: 2019
Full Text: View/download PDF

21. Utilization of mechanical power and associations with clinical outcomes in brain injured patients: a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial

Author: Wahlster, Sarah, Sharma, Monisha, Taran, Shaurya, Town, James A, Stevens, Robert D, Cinotti, Raphaël, Asehoune, Karim, Pelosi, Paolo, Robba, Chiara, Paër-Sélim Abback, Anaïs Codorniu, Giuseppe Citerio, Vittoria Ludovica Sala, Marinella Astuto, Eleonora Tringali, Daniela Alampi, Monica Rocco, Jessica Giuseppina Maugeri, Agrippino Bellissima, Matteo Filippini, Nicoletta Lazzeri, Andrea Cortegiani, Mariachiara Ippolito, Denise Battaglini, Patrick Biston, Mohamed Fathi Al-Gharyani, Russell Chabanne, Léo Astier, Benjamin Soyer, Samuel Gaugain, Alice Zimmerli, Urs Pietsch, Miodrag Filipovic, Giovanna Brandi, Giulio Bicciato, Ainhoa Serrano, Berta Monleon, Peter van Vliet, Benjamin Marcel Gerretsen, Iris Xochitl Ortiz-Macias, Jun Oto, Noriya Enomoto, Tomomichi Matsuda, Nobutaka Masui, Pierre Garçon, Jonathan Zarka, Wytze J Vermeijden, Alexander Daniel Cornet, Sergio Reyes Inurrigarro, Rafael Cirino Lara Domínguez, Maria Mercedes Bellini, Maria Milagros Gomez Haedo, Laura Lamot, Jose Orquera, Matthieu Biais, Delphine Georges, Arvind Baronia, Roberto Carlos Miranda-Ackerman, Francisco José Barbosa-Camacho, John Porter, Miguel Lopez-Morales, Thomas Geeraerts, Baptiste Compagnon, David Pérez-Torres, Estefanía Prol-Silva, Hana Basheer Yahya, Ala Khaled, Mohamed Ghula, Cracchiolo Neville Andrea, Palma Maria Daniela, Cristian Deana, Luigi Vetrugno, Manuel J Rivera Chavez, Rocio Mendoza Trujillo, Vincent Legros, Benjamin Brochet, Olivier Huet, Marie Geslain, Mathieu van der Jagt, Job van Steenkiste, Hazem Ahmed, Alexander Edward Coombs, Jessie Welbourne, Ana Alicia Velarde Pineda, Víctor Hugo Nubert Castillo, Mohammed A Azab, Ahmed Y Azzam, David Michael Paul van Meenen, Gilberto Adrian Gasca, Alfredo Arellano, Forttino Galicia-Espinosa, José Carlos García-Ramos, Ghanshyam Yadav, Amarendra Kumar Jha, Vincent Robert-Edan, Pierre-Andre Rodie-Talbere, Gaurav Jain, Sagarika Panda, Sonika Agarwal, Yashbir Deewan, Syed Tariq Reza, Md Mozaffer Hossain, Christos Papadas, Vasiliki Chantziara, Chrysanthi Sklavou, Yannick Hourmant, Nicolas Grillot, Romain Pirracchio, Abdelraouf Akkari, Mohamed Abdelaty, Ahmed Hashim, Yoann Launey, Elodie Masseret, Sigismond Lasocki, Soizic Gergaud, Nicolas Mouclier, Sulekha Saxena, Avinash Agrawal, Shakti Bedanta Mishra, Samir Samal, Julio Cesar Mijangos, Mattias Haënggi, Mohan Gurjar, Marcus J Schultz, Callum Kaye, Daniela Agustin Godoy, Pablo Alvarez, Aikaterini Ioakeimidou, Yoshitoyo Ueno, Rafael Badenes, Abdurrahmaan Ali Suei Elbuzidi, Michaël Piagnerelli, Muhammed Elhadi, Jean Catherine Digitale, Nicholas Fong, Ricardo Campos Cerda, Norma de la Torre Peredo, Wahlster, S, Sharma, M, Taran, S, Town, J, Stevens, R, Cinotti, R, Asehoune, K, Pelosi, P, Robba, C, Abback, P, Codorniu, A, Citerio, G, Sala, V, Astuto, M, Tringali, E, Alampi, D, Rocco, M, Maugeri, J, Bellissima, A, Filippini, M, Lazzeri, N, Cortegiani, A, Ippolito, M, Battaglini, D, Biston, P, Al-Gharyani, M, Chabanne, R, Astier, L, Soyer, B, Gaugain, S, Zimmerli, A, Pietsch, U, Filipovic, M, Brandi, G, Bicciato, G, Serrano, A, Monleon, B, van Vliet, P, Gerretsen, B, Ortiz-Macias, I, Oto, J, Enomoto, N, Matsuda, T, Masui, N, Garcon, P, Zarka, J, Vermeijden, W, Cornet, A, Inurrigarro, S, Dominguez, R, Bellini, M, Gomez Haedo, M, Lamot, L, Orquera, J, Biais, M, Georges, D, Baronia, A, Miranda-Ackerman, R, Barbosa-Camacho, F, Porter, J, Lopez-Morales, M, Geeraerts, T, Compagnon, B, Perez-Torres, D, Prol-Silva, E, Yahya, H, Khaled, A, Ghula, M, Andrea, C, Daniela, P, Deana, C, Vetrugno, L, Chavez, M, Trujillo, R, Legros, V, Brochet, B, Huet, O, Geslain, M, van der Jagt, M, van Steenkiste, J, Ahmed, H, Coombs, A, Welbourne, J, Velarde Pineda, A, Nubert Castillo, V, Azab, M, Azzam, A, van Meenen, D, Gasca, G, Arellano, A, Galicia-Espinosa, F, Garcia-Ramos, J, Yadav, G, Jha, A, Robert-Edan, V, Rodie-Talbere, P, Jain, G, Panda, S, Agarwal, S, Deewan, Y, Reza, S, Hossain, M, Papadas, C, Chantziara, V, Sklavou, C, Hourmant, Y, Grillot, N, Pirracchio, R, Akkari, A, Abdelaty, M, Hashim, A, Launey, Y, Masseret, E, Lasocki, S, Gergaud, S, Mouclier, N, Saxena, S, Agrawal, A, Mishra, S, Samal, S, Mijangos, J, Haenggi, M, Gurjar, M, Schultz, M, Kaye, C, Godoy, D, Alvarez, P, Ioakeimidou, A, Ueno, Y, Badenes, R, Suei Elbuzidi, A, Piagnerelli, M, Elhadi, M, Digitale, J, Fong, N, Cerda, R, de la Torre Peredo, N, Wahlster, Sarah, Sharma, Monisha, Taran, Shaurya, Town, James A, Stevens, Robert D, Cinotti, Raphaël, Asehoune, Karim, Pelosi, Paolo, Robba, Chiara, and Paër-Sélim Abback, Anaïs Codorniu, Giuseppe Citerio, Vittoria Ludovica Sala, Marinella Astuto, Eleonora Tringali, Daniela Alampi, Monica Rocco, Jessica Giuseppina Maugeri, Agrippino Bellissima, Matteo Filippini, Nicoletta Lazzeri, Andrea Cortegiani, Mariachiara Ippolito, Denise Battaglini, Patrick Biston, Mohamed Fathi Al-Gharyani, Russell Chabanne, Léo Astier, Benjamin Soyer, Samuel Gaugain, Alice Zimmerli, Urs Pietsch, Miodrag Filipovic, Giovanna Brandi, Giulio Bicciato, Ainhoa Serrano, Berta Monleon, Peter van Vliet, Benjamin Marcel Gerretsen, Iris Xochitl Ortiz-Macias, Jun Oto, Noriya Enomoto, Tomomichi Matsuda, Nobutaka Masui, Pierre Garçon, Jonathan Zarka, Wytze J Vermeijden, Alexander Daniel Cornet, Sergio Reyes Inurrigarro, Rafael Cirino Lara Domínguez, Maria Mercedes Bellini, Maria Milagros Gomez Haedo, Laura Lamot, Jose Orquera, Matthieu Biais, Delphine Georges, Arvind Baronia, Roberto Carlos Miranda-Ackerman, Francisco José Barbosa-Camacho, John Porter, Miguel Lopez-Morales, Thomas Geeraerts, Baptiste Compagnon, David Pérez-Torres, Estefanía Prol-Silva, Hana Basheer Yahya, Ala Khaled, Mohamed Ghula, Cracchiolo Neville Andrea, Palma Maria Daniela, Cristian Deana, Luigi Vetrugno, Manuel J Rivera Chavez, Rocio Mendoza Trujillo, Vincent Legros, Benjamin Brochet, Olivier Huet, Marie Geslain, Mathieu van der Jagt, Job van Steenkiste, Hazem Ahmed, Alexander Edward Coombs, Jessie Welbourne, Ana Alicia Velarde Pineda, Víctor Hugo Nubert Castillo, Mohammed A Azab, Ahmed Y Azzam, David Michael Paul van Meenen, Gilberto Adrian Gasca, Alfredo Arellano, Forttino Galicia-Espinosa, José Carlos García-Ramos, Ghanshyam Yadav, Amarendra Kumar Jha, Vincent Robert-Edan, Pierre-Andre Rodie-Talbere, Gaurav Jain, Sagarika Panda, Sonika Agarwal, Yashbir Deewan, Gilberto Adrian Gasca, Alfredo Arellano, Syed Tariq Reza, Md Mozaffer Hossain, Christos Papadas, Vasiliki Chantziara, Chrysanthi Sklavou, Yannick Hourmant, Nicolas Grillot, Job van Steenkiste, Mathieu van der Jagt, Romain Pirracchio, Abdelraouf Akkari, Mohamed Abdelaty, Ahmed Hashim, Yoann Launey, Elodie Masseret, Sigismond Lasocki, Soizic Gergaud, Nicolas Mouclier, Sulekha Saxena, Avinash Agrawal, Shakti Bedanta Mishra, Samir Samal, Julio Cesar Mijangos, Mattias Haënggi, Mohan Gurjar, Marcus J Schultz, Callum Kaye, Daniela Agustin Godoy, Pablo Alvarez, Aikaterini Ioakeimidou, Yoshitoyo Ueno, Rafael Badenes, Abdurrahmaan Ali Suei Elbuzidi, Michaël Piagnerelli, Muhammed Elhadi, Syed Tariq Reza, Jean Catherine Digitale, Nicholas Fong, Ricardo Campos Cerda, Norma de la Torre Peredo
Subjects: Mechanical power, Mechanical ventilation, Traumatic brain injury, Acute respiratory distress syndrome, Acute ischemic stroke, Acute brain injury, Intracranial hemorrhage, Subarachnoid hemorrhage
Abstract: Background: There is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes. Methods: In this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required mechanical ventilation (MV) ≥ 24h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS). Results: We included 1217 patients (mean age 51.2years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9J/min [IQR 9.2-15.1], 13J/min [IQR 10-17], and 14J/min [IQR 11-20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9J/min, aRR at 17J/min was 1.22, 95% CI 1.14-1.30) and HD3 (1.38, 95% CI 1.23-1.53), reintubation on HD1 (1.64; 95% CI 1.57-1.72), and tracheostomy on HD7 (1.53; 95%CI 1.18-1.99). MP was associated with the development of moderate-severe ARDS on HD1 (2.07; 95% CI 1.56-2.78) and HD3 (1.76; 95% CI 1.41-2.22). Conclusions: Exposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity. Potential benefits of optimizing ventilator settings to limit MP warrant further investigation.
Published: 2023

22. Effects of Resistance Exercise with or without Whey Protein Supplementation on Ocular Changes after a 21-Day Head-Down Bed Rest

Author: Marc Kermorgant, Sirine Hammoud, Laurence Mahieu, Thomas Geeraerts, Arnaud Beck, Marie-Pierre Bareille, Vincent Soler, Anne Pavy-Le Traon, and Jean-Claude Quintyn
Subjects: optical coherence tomography, intraocular pressure, head-down bed rest, microgravity, Science
Abstract: Neuro-ophthalmological changes have been reported after prolonged exposure to microgravity; however, the pathophysiology remains unclear. The objectives of the present study were twofold: (1) to assess the neuro-ophthalmological impact of 21 days of head-down bed rest (HDBR) and (2) to determine the effects of resistance vibration exercise (RVE) alone or combined with nutritional supplementation (NeX). In this case, 12 healthy male subjects completed three interventions of a 21-day HDBR: a control condition without countermeasure (CON), a condition with resistance vibration exercise (RVE) comprising of squats, single leg heel and bilateral heel raises and a condition using also RVE associated with nutritional supplementation (NeX). Intraocular pressure (IOP) was assessed by applanation tonometry. Retinal nerve fiber layer thickness (RNFLT) was assessed with spectral-domain optical coherence tomography, before HDBR and between Day 2 and Day 4 after each session of HDBR. In CON condition, IOP was preserved; while in RVE and NeX conditions, IOP was increased. In CON condition, RNFLT was preserved after HDBR. RVE and NeX conditions did not have significant effects on RNFLT. This study showed that a 3-week HDBR did not induce significant ophthalmological changes. However, RVE induced an elevation in IOP after HDBR. Nutritional supplementation did not reduce or exacerbate the side effects of RVE.
Published: 2021
Full Text: View/download PDF

23. Mise au point sur la prise en charge du traumatisé crânien grave

Author: Thomas Geeraerts
Subjects: Anesthesiology and Pain Medicine
Published: 2022
Full Text: View/download PDF

24. Neural signature of coma revealed by posteromedial cortex connection density analysis

Author: Briguita Malagurski, Patrice Péran, Benjamine Sarton, Beatrice Riu, Leslie Gonzalez, Fanny Vardon-Bounes, Thierry Seguin, Thomas Geeraerts, Olivier Fourcade, Francesco de Pasquale, and Stein Silva
Subjects: Computer applications to medicine. Medical informatics, R858-859.7, Neurology. Diseases of the nervous system, RC346-429
Abstract: Posteromedial cortex (PMC) is a highly segregated and dynamic core, which appears to play a critical role in internally/externally directed cognitive processes, including conscious awareness. Nevertheless, neuroimaging studies on acquired disorders of consciousness, have traditionally explored PMC as a homogenous and indivisible structure. We suggest that a fine-grained description of intrinsic PMC topology during coma, could expand our understanding about how this cortical hub contributes to consciousness generation and maintain, and could permit the identification of specific markers related to brain injury mechanism and useful for neurological prognostication.To explore this, we used a recently developed voxel-based unbiased approach, named functional connectivity density (CD). We compared 27 comatose patients (15 traumatic and 12 anoxic), to 14 age-matched healthy controls. The patients' outcome was assessed 3months later using Coma Recovery Scale-Revised (CRS-R).A complex pattern of decreased and increased connections was observed, suggesting a network imbalance between internal/external processing systems, within PMC during coma. The number of PMC voxels with hypo-CD positive correlation showed a significant negative association with the CRS-R score, notwithstanding aetiology. Traumatic injury specifically appeared to be associated with a greater prevalence of hyper-connected (negative correlation) voxels, which was inversely associated with patient neurological outcome. A logistic regression model using the number of hypo-CD positive and hyper-CD negative correlations, accurately permitted patient's outcome prediction (AUC=0.906, 95%IC=0.795–1). These points might reflect adaptive plasticity mechanism and pave the way for innovative prognosis and therapeutics methods. Keywords: Acute brain injury, Coma, Connection density, Prognosis, Resting state
Published: 2017
Full Text: View/download PDF

25. Reversible Cerebral Vasoconstriction Syndrome with Intracranial Hypertension: Should Decompressive Craniectomy Be Considered

Author: Ségolène Mrozek, Laurent Lonjaret, Aude Jaffre, Anne-Christine Januel, Nicolas Raposo, Sergio Boetto, Jean-François Albucher, Olivier Fourcade, and Thomas Geeraerts
Subjects: Reversible cerebral vasoconstriction syndrome, Decompressive craniectomy, Intracerebral hemorrhage, Intracranial hypertension, Neurology. Diseases of the nervous system, RC346-429
Abstract: Background: Reversible cerebral vasoconstriction syndrome (RCVS) is a rare cause of intracerebral hemorrhage (ICH) causing intracranial hypertension. Methods: Case report. Results: We report a case of RCVS-related ICH leading to refractory intracranial hypertension. A decompressive craniectomy was performed to control intracranial pressure. We discuss here the management of RCVS with intracranial hypertension. Decompressive craniectomy was preformed to avoid the risky option of high cerebral perfusion pressure management with the risk of bleeding, hemorrhagic complications, and high doses of norepinephrine. Neurological outcome was good. Conclusion: RCVS has a complex pathophysiology and can be very difficult to manage in cases of intracranial hypertension. Decompressive craniectomy should probably be considered.
Published: 2017
Full Text: View/download PDF

26. Mass Training In Situ During COVID-19 Pandemic

Author: Charles-Henri Houze-Cerfon, Stein Silva, Vincent Minville, Marilyne Fernandes, Rachel Rigal, Sébastien Couarraze, Thomas Geeraerts, Fanny Vardon-Bounes, Richard Pizzuto, Fouad Marhar, Jean Ruiz, Thierry Seguin, Bernard Georges, Muriel Legendre, Béatrice Riu, Louis Delamarre, Claire Larcher, Sandra Malavaud, Diane Osinski, Fabrice Ferré, Olivier Mathe, and Olivier Fourcade
Subjects: training, Coronavirus disease 2019 (COVID-19), SARS-CoV-2, healthcare workers, Epidemiology, business.industry, Training (meteorology), COVID-19, sick leave, Medicine (miscellaneous), simulation, medicine.disease, Education, Personnel, Hospital, Contamination, Modeling and Simulation, Pandemic, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Humans, Medicine, Empirical Investigations, Medical emergency, business, Pandemics
Abstract: Supplemental digital content is available in the text., Introduction Avoiding coronavirus disease 2019 (COVID-19) work-related infection in frontline healthcare workers is a major challenge. A massive training program was launched in our university hospital for anesthesia/intensive care unit and operating room staff, aiming at upskilling 2249 healthcare workers for COVID-19 patients' management. We hypothesized that such a massive training was feasible in a 2-week time frame and efficient in avoiding sick leaves. Methods We performed a retrospective observational study. Training focused on personal protective equipment donning/doffing and airway management in a COVID-19 simulated patient. The educational models used were in situ procedural and immersive simulation, peer-teaching, and rapid cycle deliberate practice. Self-learning organization principles were used for trainers' management. Ordinary disease quantity in full-time equivalent in March and April 2020 were compared with the same period in 2017, 2018, and 2019. Results A total of 1668 healthcare workers were trained (74.2% of the target population) in 99 training sessions over 11 days. The median number of learners per session was 16 (interquartile range = 9–25). In the first 5 days, the median number of people trained per weekday was 311 (interquartile range = 124–385). Sick leaves did not increase in March to April 2020 compared with the same period in the 3 preceding years. Conclusions Massive training for COVID-19 patient management in frontline healthcare workers is feasible in a very short time and efficient in limiting the rate of sick leave. This experience could be used in the anticipation of new COVID-19 waves or for rapidly preparing hospital staff for an unexpected major health crisis.
Published: 2022
Full Text: View/download PDF

27. La simulation numérique, entre la perception des formateurs et celle des étudiants infirmiers

Author: Thomas Geeraerts, Nathalie Huet, and Guillaume Decormeille
Subjects: Health Policy, Psychology, General Nursing
Published: 2021
Full Text: View/download PDF

28. Cerebral perfusion using ASL in patients with COVID-19 and neurological manifestations: A retrospective multicenter observational study

Author: François-Daniel Ardellier, Seyyid Baloglu, Magdalena Sokolska, Vincent Noblet, François Lersy, Olivier Collange, Jean-Christophe Ferré, Adel Maamar, Béatrice Carsin-Nicol, Julie Helms, Maleka Schenck, Antoine Khalil, Augustin Gaudemer, Sophie Caillard, Julien Pottecher, Nicolas Lefèbvre, Pierre-Emmanuel Zorn, Muriel Matthieu, Jean Christophe Brisset, Clotilde Boulay, Véronique Mutschler, Yves Hansmann, Paul-Michel Mertes, Francis Schneider, Samira Fafi-Kremer, Mickael Ohana, Ferhat Meziani, Nicolas Meyer, Tarek Yousry, Mathieu Anheim, François Cotton, Hans Rolf Jäger, Stéphane Kremer, Fabrice Bonneville, Gilles Adam, Guillaume Martin-Blondel, Jérémie Pariente, Thomas Geeraerts, Hélène Oesterlé, Federico Bolognini, Julien Messie, Ghazi Hmeydia, Joseph Benzakoun, Catherine Oppenheim, Jean-Marc Constans, Serge Metanbou, Adrien Heintz, Blanche Bapst, Imen Megdiche, Lavinia Jager, Patrick Nesser, Yannick Talla Mba, Thomas Tourdias, Juliette Coutureau, Céline Hemmert, Philippe Feuerstein, Nathan Sebag, Sophie Carre, Manel Alleg, Claire Lecocq, Emmanuel Schmitt, René Anxionnat, François Zhu, Géraud Forestier, Aymeric Rouchaud, Pierre-Olivier Comby, Frederic Ricolfi, Pierre Thouant, Sylvie Grand, Alexandre Krainik, Isaure de Beaurepaire, Grégoire Bornet, Audrey Lacalm, Patrick Miailhes, Julie Pique, Claire Boutet, Xavier Fabre, Béatrice Claise, Sonia Mirafzal, Laure Calvet, Hubert Desal, Jérome Berge, Grégoire Boulouis, Apolline Kazemi, Nadya Pyatigorskaya, Augustin Lecler, Suzana Saleme, Myriam Edjlali-Goujon, Basile Kerleroux, Jean-Christophe Brisset, Samir Chenaf, Les Hôpitaux Universitaires de Strasbourg (HUS), Hôpital de Hautepierre [Strasbourg], Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), University College of London [London] (UCL), Nouvel Hôpital Civil de Strasbourg, Département de Neuroradiology [Rennes], Neuroimagerie: méthodes et applications (EMPENN), 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)-SIGNAL, IMAGE ET LANGAGE (IRISA-D6), 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)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-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)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), CHU Pontchaillou [Rennes], Service de Médecine Intensive et Réanimation [Strasbourg], CHU Strasbourg, Département de Radiologie [Bichat] (DR- 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), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Immuno-Rhumatologie Moléculaire, Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Groupe d'Analyse des Itinéraires et des Niveaux Salariaux (GAINS), Le Mans Université (UM), Les Hôptaux universitaires de Strasbourg (HUS), Observatoire Français de la Sclérose En Plaques [Lyon] (OFSEP), Centre for Integrative Biology - CBI (Inserm U964 - CNRS UMR7104 - IGBMC), Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hôpital Louis Pasteur [Colmar] (CH Colmar), Hôpital Sainte-Anne [Paris], CHU Amiens-Picardie, CHirurgie, IMagerie et REgénération tissulaire de l’extrémité céphalique - Caractérisation morphologique et fonctionnelle - UR UPJV 7516 (CHIMERE), Université de Picardie Jules Verne (UPJV), SFNR-COVID Group, CHU Henri Mondor [Créteil], Hôpital Marie Madeleine [Forbach] (CHIC Unisanté+), CHU de Bordeaux Pellegrin [Bordeaux], Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA), Centre Hospitalier de Haguenau, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hôpital Dupuytren [CHU Limoges], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Universitaire [Grenoble] (CHU), Hôpital privé d’Antony, Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), CHU Clermont-Ferrand, and Société Française de Neuroradiologie [Paris] (SFNR)
Subjects: Multicenter Study, Radiological and Ultrasound Technology, Cerebrovascular Circulation, COVID-19, Radiology, Nuclear Medicine and imaging, Neuroimaging, Neurology (clinical), Magnetic Resonance Imaging, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; Background and purpose: Cerebral hypoperfusion has been reported in patients with COVID-19 and neurological manifestations in small cohorts. We aimed to systematically assess changes in cerebral perfusion in a cohort of 59 of these patients, with or without abnormalities on morphological MRI sequences.Methods: Patients with biologically-confirmed COVID-19 and neurological manifestations undergoing a brain MRI with technically adequate arterial spin labeling (ASL) perfusion were included in this retrospective multicenter study. ASL maps were jointly reviewed by two readers blinded to clinical data. They assessed abnormal perfusion in four regions of interest in each brain hemisphere: frontal lobe, parietal lobe, posterior temporal lobe, and temporal pole extended to the amygdalo-hippocampal complex.Results: Fifty-nine patients (44 men (75%), mean age 61.2 years) were included. Most patients had a severe COVID-19, 57 (97%) needed oxygen therapy and 43 (73%) were hospitalized in intensive care unit at the time of MRI. Morphological brain MRI was abnormal in 44 (75%) patients. ASL perfusion was abnormal in 53 (90%) patients, and particularly in all patients with normal morphological MRI. Hypoperfusion occurred in 48 (81%) patients, mostly in temporal poles (52 (44%)) and frontal lobes (40 (34%)). Hyperperfusion occurred in 9 (15%) patients and was closely associated with post-contrast FLAIR leptomeningeal enhancement (100% [66.4%-100%] of hyperperfusion with enhancement versus 28.6% [16.6%-43.2%] without, p=0.002). Studied clinical parameters (especially sedation) and other morphological MRI anomalies had no significant impact on perfusion anomalies.Conclusion: Brain ASL perfusion showed hypoperfusion in more than 80% of patients with severe COVID-19, with or without visible lesion on conventional MRI abnormalities.
Published: 2023
Full Text: View/download PDF

29. Impacts of Simulated Weightlessness by Dry Immersion on Optic Nerve Sheath Diameter and Cerebral Autoregulation

Author: Marc Kermorgant, Florian Leca, Nathalie Nasr, Marc-Antoine Custaud, Thomas Geeraerts, Marek Czosnyka, Dina N. Arvanitis, Jean-Michel Senard, and Anne Pavy-Le Traon
Subjects: transcranial Doppler, cerebral autoregulation, optic nerve sheath diameter, intracranial pressure, dry immersion, Physiology, QP1-981
Abstract: Dry immersion (DI) is used to simulate weightlessness. We investigated in healthy volunteers if DI induces changes in ONSD, as a surrogate marker of intracranial pressure (ICP) and how these changes could affect cerebral autoregulation (CA). Changes in ICP were indirectly measured by changes in optic nerve sheath diameter (ONSD). 12 healthy male volunteers underwent 3 days of DI. ONSD was indirectly assessed by ocular ultrasonography. Cerebral blood flow velocity (CBFV) of the middle cerebral artery was gauged using transcranial Doppler ultrasonography. CA was evaluated by two methods: (1) transfer function analysis was calculated to determine the relationship between mean CBFV and mean arterial blood pressure (ABP) and (2) correlation index Mxa between mean CBFV and mean ABP.ONSD increased significantly during the first day, the third day and the first day of recovery of DI (P < 0.001).DI induced a reduction in Mxa index (P < 0.001) and an elevation in phase shift in low frequency bandwidth (P < 0.05). After DI, Mxa and coherence were strongly correlated with ONSD (P < 0.05) but not before DI. These results indicate that 3 days of DI induces significant changes in ONSD most likely reflecting an increase in ICP. CA was improved but also negatively correlated with ONSD suggesting that a persistent elevation ICP favors poor CA recovery after simulated microgravity.
Published: 2017
Full Text: View/download PDF

30. Clinical gesture in dental education: Presentation of a new immersive virtual reality application in first person point‐of‐view

Author: Delphine, Maret, Sophie, Barrere, Maxime, Ros, and Thomas, Geeraerts
Subjects: General Medicine
Published: 2022
Full Text: View/download PDF

31. Urgence vitale et monitoring non invasif chez le patient cérébrolésé à la prise en charge initiale

Author: Thomas Geeraerts
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030208 emergency & critical care medicine, 030217 neurology & neurosurgery
Abstract: Resume Le Doppler transcrânien (DTC) permet la mesure non invasive de la vitesse des globules rouges dans les gros troncs arteriels cerebraux. La vitesse moyenne des globules rouges (Vm) mesuree par le Doppler est un temoin indirect du debit sanguin cerebral. Pour l’artere cerebrale moyenne, la mesure de l’index de pulsatilite (IP, valeur normale pour l’artere cerebrale moyenne = 1,0 ± 0,2) et de la velocite diastolique (Vd, valeur normale pour l’artere cerebrale moyenne = 40 ± 10 cm/s) permettent d’estimer l’etat des resistances distales et donc de la pression de perfusion cerebrale. Les patients a risque d’hypertension intracrânienne sont une indication pour l’utilisation du DTC en urgence afin d’estimer le debit sanguin cerebral. L’echographie oculaire avec mesure du diametre des enveloppes du nerf optique, temoin de la pression dans le liquide cephalorachidien, permet d’estimer le risque d’hypertension intracrânienne. Un diametre des enveloppes du nerf optique normal en echographie oculaire permet d’eliminer une hypertension intracrânienne.
Published: 2021
Full Text: View/download PDF

32. Immunohistologic Features of Cerebral Venous Thrombosis Due to Vaccine-Induced Immune Thrombotic Thrombocytopenia

Author: Thomas Geeraerts, Céline Guilbeau-Frugier, Cédric Garcia, Vincent Memier, Nicolas Raposo, Fabrice Bonneville, Céline Gales, Jean Darcourt, Sophie Voisin, Agnès Ribes, Marie Piel-Julian, Fanny Bounes, Jean François Albucher, Franck-Emmanuel Roux, Jacques Izopet, Norbert Telmon, Jean Marc Olivot, Pierre Sié, Jan Bauer, Bernard Payrastre, and Roland S. Liblau
Subjects: Neurology, Neurology (clinical)
Abstract: ObjectivesVaccine-induced immune thrombotic thrombocytopenia (VITT), a recently described entity characterized by thrombosis at unusual locations such as cerebral venous sinus and splanchnic vein, has been rarely described after adenoviral-encoded COVID-19 vaccines. In this study, we report the immunohistological correlates in 3 fatal cases of cerebral venous thrombosis related to VITT analyzed at an academic medical center.MethodsDetailed neuropathologic studies were performed in 3 cases of cerebral venous thrombosis related to VITT after adenoviral COVID-19 vaccination.ResultsAutopsy revealed extensive cerebral vein thrombosis in all 3 cases. Polarized thrombi were observed with a high density of neutrophils in the core and a low density in the tail. Endothelial cells adjacent to the thrombus were largely destroyed. Markers of neutrophil extracellular trap and complement activation were present at the border and within the cerebral vein thrombi. SARS-CoV-2 spike protein was detected within the thrombus and in the adjacent vessel wall.DiscussionData indicate that neutrophils and complement activation associated with antispike immunity triggered by the vaccine is probably involved in the disease process.
Published: 2023
Full Text: View/download PDF

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

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

34. Functional and Structural Integrity of Frontoparietal Connectivity in Traumatic and Anoxic Coma

Author: Vincent Minville, Béatrice Riu, Jean Albert Lotterie, Hélène Vinour, Benjamine Sarton, Jean François Albucher, Thierry Seguin, Segolène Mrozeck, Xavier Deboissezon, Briguitta Malagurski, Stein Silva, Olivier Fourcade, Federico Nemmi, Patrice Péran, Fanny Vardon Bounes, Thomas Geeraerts, David Rousset, Jean-Marc Olivot, Fabrice Ferré, and Lionel Naccache
Subjects: brain anoxia, Adult, Male, medicine.medical_specialty, Traumatic brain injury, coma, Neuroimaging, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Physical medicine and rehabilitation, Parietal Lobe, Medicine, Humans, Glasgow Coma Scale, Longitudinal Studies, Prospective Studies, Prospective cohort study, Prefrontal cortex, Aged, Univariate analysis, business.industry, Binary outcome, Online Clinical Investigations, Structural integrity, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, functional magnetic resonance imaging, Magnetic Resonance Imaging, Coma, Post-Head Injury, Frontal Lobe, Heart Arrest, 030228 respiratory system, Case-Control Studies, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, brain trauma, Female, Disconnection, prognosis, business
Abstract: Supplemental Digital Content is available in the text., Objectives: Recovery from coma might critically depend on the structural and functional integrity of frontoparietal networks. We aimed to measure this integrity in traumatic brain injury and anoxo-ischemic (cardiac arrest) coma patients by using an original multimodal MRI protocol. Design: Prospective cohort study. Setting: Three Intensive Critical Care Units affiliated to the University in Toulouse (France). Patients: We longitudinally recruited 43 coma patients (Glasgow Coma Scale at the admission < 8; 29 cardiac arrest and 14 traumatic brain injury) and 34 age-matched healthy volunteers. Exclusion criteria were disorders of consciousness lasting more than 30 days and focal brain damage within the explored brain regions. Patient assessments were conducted at least 2 days (5 ± 2 d) after complete withdrawal of sedation. All patients were followed up (Coma Recovery Scale-Revised) 3 months after acute brain injury. Interventions: None. Measurements and Main Results: Functional and structural MRI data were recorded, and the analysis was targeted on the posteromedial cortex, the medial prefrontal cortex, and the cingulum. Univariate analyses and machine learning techniques were used to assess diagnostic and predictive values. Coma patients displayed significantly lower medial prefrontal cortex–posteromedial cortex functional connectivity (area under the curve, 0.94; 95% CI, 0.93–0.95). Cardiac arrest patients showed specific structural disturbances within posteromedial cortex. Significant cingulum architectural disturbances were observed in traumatic brain injury patients. The machine learning medial prefrontal cortex–posteromedial cortex multimodal classifier had a significant predictive value (area under the curve, 0.96; 95% CI, 0.95–0.97), best combination of subregions that discriminates a binary outcome based on Coma Recovery Scale-Revised). Conclusions: This exploratory study suggests that frontoparietal functional disconnections are specifically observed in coma and their structural counterpart provides information about brain injury mechanisms. Multimodal MRI biomarkers of frontoparietal disconnection predict 3-month outcome in our sample. These findings suggest that fronto-parietal disconnection might be particularly relevant for coma outcome prediction and could inspire innovative precision medicine approaches.
Published: 2020

35. Simulation-based teaching in critical care, anaesthesia and emergency medicine

Author: Jean-Philippe Desclefs, Thomas Geeraerts, Erwan L'Her, Chirine Mossadegh, François Lecomte, Charles Cerf, Antonia Blanié, Marc Garnier, Véronique Delmas, Dan Benhamou, Mercedes Jourdain, and Islem Ouanes
Subjects: medicine.medical_specialty, Anesthesiology and Pain Medicine, business.industry, Emergency medicine, Medicine, General Medicine, Critical Care and Intensive Care Medicine, business, Simulation based
Published: 2020
Full Text: View/download PDF

36. French recommendations for the management of patients with spinal cord injury or at risk of spinal cord injury

Author: E. Cesareo, C. Court, Jean-François Payen, Aurore Rodrigues, Patrick Tropiano, Karim Tazarourte, Antoine Roquilly, Hervé Quintard, B. Perrouin-Verbe, Mathieu Boutonnet, V. Vermeersch, T. Gauss, P. Denys, Kevin Buffenoir, Pierre Bouzat, A.C. de Crouy, Thomas Geeraerts, V. Martinez, Bertrand Prunet, Fabrice Cook, Stéphane Fuentes, B Vigué, Lionel Velly, Anthony Chauvin, Christian Laplace, and Jacques Duranteau
Subjects: Mechanical ventilation, medicine.medical_specialty, Resuscitation, business.industry, medicine.medical_treatment, 030208 emergency & critical care medicine, General Medicine, Evidence-based medicine, Critical Care and Intensive Care Medicine, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, medicine, Physical therapy, Sampling (medicine), Paraplegia, business, Grading (education), Tetraplegia, Spinal cord injury
Abstract: Objectives To update the French guidelines on the management of trauma patients with spinal cord injury or suspected spinal cord injury. Design A consensus committee of 27 experts was formed. A formal conflict-of-interest (COI) policy was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e. pharmaceutical, medical devices). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Methods The committee studied twelve questions: (1) What are the indications and arrangements for spinal immobilisation? (2) What are the arrangements for pre-hospital orotracheal intubation? (3) What are the objectives of haemodynamic resuscitation during the lesion assessment, and during the first few days in hospital? (4) What is the best way to manage these patients to improve their long-term prognosis? (5) What is the place of corticosteroid therapy in the initial phase? (6) What are the indications for magnetic resonance imaging in the lesion assessment phase? (7) What is the optimal time for surgical management? (8) What are the best arrangements for orotracheal intubation in the hospital environment? (9) What are the specific conditions for weaning these patients from mechanical ventilation for? (10) What are the procedures for analgesic treatment of these patients? (11) What are the specific arrangements for installing and mobilising these patients? (12) What is the place of early intermittent bladder sampling in these patients? Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® Methodology. Results The experts’ work synthesis and the application of the GRADE method resulted in 19 recommendations. Among the recommendations formalised, 2 have a high level of evidence (GRADE 1+/−) and 12 have a low level of evidence (GRADE 2+/−). For 5 recommendations, the GRADE method could not be applied, resulting in expert advice. After two rounds of scoring and one amendment, strong agreement was reached on all the recommendations. Conclusions There was significant agreement among experts on strong recommendations to improve practices for the management of patients with spinal cord injury.
Published: 2020
Full Text: View/download PDF

37. Perioperative risk assessment of patients using the ‘MyRISK’ digital score completed before the preanesthetic consultation: a prospective, observational trial. (Preprint)

Author: Fabrice Ferré, Rodolphe Laurent, Philippine Furelau, Emmanuel Doumard, Anne Ferrier, Laetitia Bosch, Cyndie Ba, Rémi Menut, Matt Kurrek, Thomas Geeraerts, Antoine Piau, and Vincent Minville
Abstract: BACKGROUND The pandemic highlighted the potential of digital health solutions to adapt the organization of care in a crisis context. OBJECTIVE Our aim was to demonstrate the prognostic value of the perioperative ‘MyRISK score’ derived from data collected on a digital conversational agent (chatbot) before the preanesthetic consultation (PAC). METHODS Single-center, prospective, observational study. The 16 items composing the MyRISK score were selected by Delphi method. An algorithm was used to stratify low (‘green’), intermediate (‘orange’) and high (‘red’) risk patients. Postoperative complications occurring in the first 6 months (composite criterion) were numerically collected and verified by phone and consultation of the electronic medical database. A logistic regression was carried out to identify their explanatory variables. A machine learning model was trained to predict the MyRISK score using a dataset of 1823 ‘green’ and ‘red’ patients to re-classify ‘orange’ individuals. User satisfaction and usability were assessed. RESULTS Four hundered and one patients were included. Sixteen of the 389 patients (4.1%) analyzed for the primary endpoint experienced a postoperative complication. An ASA score ≥ 3 and a ‘red’ score were independent predictors of postoperative complications (Odds Ratios of 5.8 [CI95%: 1.7 - 20.2; p=0.006] and 5.9 [CI95%: 1.5 - 22.3; p=0.009] respectively). Once ‘orange’ patients re-classified according to the prediction of the trained model, a ‘red’ score was identified as a strong predictor of postoperative complications with an Odds Ratio of 21.8 [CI95%: 2.8 - 171.5; p=0.003]. Patient satisfaction Numeric Rating Scale and System Usability Scale were 8 [7-9]/10 and 90 [82.5-95]/100 respectively. CONCLUSIONS We demonstrate the good prognostic predictive value of the MyRISK digital perioperative risk score established before the PAC. Its predictive strength was increase using a machine learning model reclassifying intermediate-risk patient. This numerical categorization could be used to guide patients between teleconsultation and face-to-face PAC, or to provide a perioperative personalized care pathway for high-risk patients.
Published: 2022
Full Text: View/download PDF

38. Intrahospital Trauma Flowcharts - cognitive aids for intrahospital trauma management from the French Society of Anaesthesia and Intensive Care Medicine and the French Society of Emergency Medicine

Author: Tobias Gauss, Hervé Quintard, Benjamin Bijok, Guillaume Bouhours, Thomas Clavier, Fabrice Cook, Hugues de Courson, Jean-Stéphane David, Caroline Duracher-Gout, Delphine Garrigue, Thomas Geeraerts, Sophie Hamada, Olivier Joannes-Boyau, Romain Jouffroy, Antoine Lamblin, Olivier Langeron, Pierre Lanot, Sigismond Lasocki, Marc Leone, Sébastien Mirek, Laurent Muller, Pierre Pasquier, Bertrand Prunet, Sébastien Perbet, Mathieu Raux, Justin Richards, Claire Roger, Antoine Roquilly, Emmanuel Weiss, Pierre Bouzat, Julien Pottecher, Bordeaux population health (BPH), and Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Anesthesiology and Pain Medicine, Traumatic Brain Injury, Resuscitation, Cognitive aid, Shock, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, General Medicine, Guideline, Damage Control, Critical Care and Intensive Care Medicine, Trauma
Published: 2022
Full Text: View/download PDF

39. Anaesthetic and peri-operative management for thrombectomy procedures in stroke patients

Author: Hervé Quintard, Vincent Degos, Mikael Mazighi, Jérôme Berge, Pierre Boussemart, Russel Chabanne, Samy Figueiredo, Thomas Geeraerts, Yoann Launey, Ludovic Meuret, Jean-Marc Olivot, Julien Pottecher, Francesca Rapido, Sébastien Richard, Suzana Saleme, Virginie Siguret-Depasse, Olivier Naggara, Hugues De Courson, and Marc Garnier
Subjects: Anesthesiology and Pain Medicine, General Medicine, Critical Care and Intensive Care Medicine
Published: 2023
Full Text: View/download PDF

40. Le Congrès annuel 2022 de la SFAR : le plaisir de se retrouver, de partager et d’apprendre ensemble

Author: Thomas Geeraerts, Pierre Bouzat, and Pierre Albaladejo
Subjects: Anesthesiology and Pain Medicine
Published: 2022
Full Text: View/download PDF

41. Neurosurgical Patient in ICU: Usefulness of Transcranial Doppler (TCD/TCCS) in Postoperative Monitoring

Author: Camilo N. Rodríguez and Thomas Geeraerts
Subjects: medicine.medical_specialty, business.industry, Hemodynamics, Blood flow, Intensive care unit, law.invention, Transcranial Doppler, Cerebral blood flow, law, Anesthesia, Parenchyma, medicine, Neurosurgery, business, Perfusion
Abstract: Neurosurgical patients frequently require admission to intensive care unit (ICU), either for postoperative management or for treating complications. Postoperative neurosurgical monitoring has two interrelated goals related to secondary brain injury: (1) early detection of neurologic deterioration (neuroworsening) facilitating timely intervention, and (2) maintenance or reestablishment of systemic and neurologic homeostasis. The multimodal monitoring (MMM) approach aims to optimize patient care, if necessary, to ensure optimal brain tissue perfusion, maintaining a sufficient blood flow to supply energy and oxygen to the brain parenchyma. Therefore, transcranial Doppler (TCD) and transcranial color-coded duplex sonography (TCCS) (as a part of MMM) are noninvasive bedside monitoring techniques that can evaluate cerebral blood flow hemodynamics and brain parenchyma structures, allowing real-time assessment of cerebral blood flow velocity (CBFV) and bedside monitoring changes in the brain parenchyma during postoperative management.
Published: 2021
Full Text: View/download PDF

42. How does head position induced intracranial pressure changes impact sympathetic activity and cerebral blood flow?

Author: Marc, Kermorgant, Marc, Labrunée, Fabien, Despas, Ophélie, Hélissen, Thomas, Geeraerts, Elisabeth, Lambert, Eric, Schmidt, Jean-Michel, Senard, Dina N, Arvanitis, Nathalie, Nasr, and Anne Pavy-Le, Traon
Subjects: Male, Adult, Head-Down Tilt, Cellular and Molecular Neuroscience, Sympathetic Nervous System, Intracranial Pressure, Heart Rate, Endocrine and Autonomic Systems, Cerebrovascular Circulation, Humans, Blood Pressure, Neurology (clinical), Baroreflex
Abstract: Acute head-down-tilt (HDT) simulates short duration hemodynamic impact of microgravity. We sought to determine whether an increase in ICP caused by acute HDT affects sympathetic nervous system activity and cerebral blood flow velocities (CBFV) in healthy male volunteers.HDT protocol was established as follows: basal condition immediately followed by gradual negative angles (-10°, -20° and -30°) lasting 10mn and then a return to basal condition. Velocities in the MCA (CBFV) were monitored using TCD. Sympathetic activity was assessed using MSNA. Baroreflex sensitivity (BRS) was measured using the sequence method. ICP changes were assessed using ultrasonography of the optic nerve sheath diameter (ONSD). Cerebral autoregulation (CA) was evaluated by transfer function and the autoregulatory index (Mxa).Twelve male volunteers (age: 35 ± 2 years) were included. Neither blood pressure nor heart rate was significantly modified during HDT. ONSD increased significantly at each step of HDT and remained elevated during Recovery. MSNA burst incidence increased at -30°. A positive correlation between variations in ONSD and variations in MSNA burst incidence was observed at -20°. CBFV were significantly diminished at -20° and -30. In the LF band, the transfer function coherence was reduced at -30° and the transfer function phase was increased at -30° and during Recovery.We found that an acute though modest increase in ICP induced by HDT was associated with an increase of sympathetic activity as assessed by MSNA, and with a reduction of CBFV with preserved CA.
Published: 2022
Full Text: View/download PDF

43. Clinical decision support for severe trauma patients: Machine learning based definition of a bundle of care for hemorrhagic shock and traumatic brain injury

Author: V Legros, Anatole Harrois, Romain Pirracchio, J L Hanouz, E Lang, Arthur Neuschwander, P Esnault, Gersende Favé, Thomas Geeraerts, Julien Pottecher, Sophie Hamada, Paer Selim Abback, N Mellati, Marc Leone, and E Kipnis
Subjects: Adult, Male, Emergency Medical Services, Multivariate analysis, Critical Care, Traumatic brain injury, MEDLINE, Shock, Hemorrhagic, Critical Care and Intensive Care Medicine, Machine learning, computer.software_genre, Machine Learning, Brain Injuries, Traumatic, medicine, Humans, Hospital Mortality, Registries, Univariate analysis, Trauma Severity Indices, business.industry, Mortality rate, Univariate, Evidence-based medicine, medicine.disease, Decision Support Systems, Clinical, Quality Improvement, Cohort, Practice Guidelines as Topic, Surgery, Female, Artificial intelligence, France, Guideline Adherence, business, computer, Patient Care Bundles
Abstract: Background Deviation from guidelines is frequent in emergency situations and this may lead to increased mortality. Probably because of time constraints, 55% is the greatest reported guidelines compliance rate in severe trauma patients. This study aimed to identify among all available recommendations a reasonable bundle of items that should be followed to optimize the outcome of hemorrhagic shocks (HS) and severe traumatic brain injuries (TBI). Methods We first estimated the compliance with French and European guidelines using the data from the French TraumaBase® registry. Then, we used a machine learning procedure to reduce the number of recommendations into a minimal set of items to be followed to minimize 7-day mortality. We evaluated the bundles using an external validation cohort. Results This study included 5,924 trauma patients (1,414 HS and 4,955 TBI) between 2011 and August 2019 and studied compliance to 36 recommendation items. Overall compliance rate to recommendation items was 71.6% and 66.9% for HS and TBI respectively. In HS, compliance was significantly associated with 7-day decreased mortality in univariate analysis but not in multivariate analysis (RR = 0.91, 95%CI = 0.90-1.17, p = 0.06). In TBI, compliance was significantly associated with decreased mortality in univariate and multivariate analysis (RR = 0.85, 95%CI = 0.75-0.92, p = 0.01). For HS, the bundle included 13 recommendation items. In the validation cohort, when this bundle was applied, patients were found to have a lower 7-day mortality rate (RR = 0.46, 95%CI = 0.27-0.63, p = 0.01). In TBI, the bundle included 7 items. In the validation cohort, when this bundle was applied, patients had a lower 7-day mortality rate (RR = 0.55, 95%CI = 0.34-0.71, p = 0.02). Discussion Using a machine-learning procedure, we were able to identify a subset of recommendations that minimizes 7-day mortality following traumatic HS and TBI. These two bundles remain to be evaluated in a prospective manner. Level of evidence II.
Published: 2021

44. La surveillance neurologique clinique infirmière du traumatisé crânien en réanimation

Author: Saloua Mrid, Dominique Capdordy, Thomas Geeraerts, Nadia Moussa, Ségolène Mrozek, and Gérald Dauban
Subjects: business.industry, Emergency Medicine, Medicine, Emergency Nursing, business
Published: 2021
Full Text: View/download PDF

45. COVID-19–associated acute necrotising encephalopathy successfully treated with steroids and polyvalent immunoglobulin with unusual IgG targeting the cerebral fibre network

Author: Jérôme Roustan, Fabrice Bonneville, Olivier Fourcade, Gaspard Grouteau, Etienne Aldigé, J. Pariente, David Rousset, Cédric Gollion, Louis Delamarre, Guillaume Jimena, Thomas Geeraerts, Françoise Fortenfant, Chloé Bost, François Gaussiat, Charlène Gaffard, Guillaume Martin-Blondel, Julien Duplantier, Pierre Delobel, and Charlotte Martin
Subjects: Encephalopathy, Clinical Neurology, Neurological examination, Sixth nerve palsy, neuropathology, virology, 03 medical and health sciences, 0302 clinical medicine, Cerebrospinal fluid, Intensive care, medicine, intensive care, Autoimmune encephalitis, medicine.diagnostic_test, business.industry, Glasgow Coma Scale, PostScript, medicine.disease, Hyperintensity, autoimmune encephalitis, Psychiatry and Mental health, Anesthesia, Surgery, Neurology (clinical), business, 030217 neurology & neurosurgery, steroids
Abstract: A recent case report described the radiological features of a suspected COVID-19 necrotising haemorrhagic encephalopathy.1 We present here a description of clinical, biological, radiological and immunological features of a COVID-19 patient case, evocative of virus-associated acute necrotising encephalopathy (ANE) possibly mediated by antibodies. Patient’s representative consent has been obtained in agreement with the journal’s policy. A 51-year-old man without personal or family history of neurological disease was hospitalised after 10 days of fever and cough. COVID-19 was diagnosed by reverse-transcriptase PCR on nasal swab and bilateral ground-glass opacities on thoracic CT scan. At day 12, he was admitted in intensive care unit (ICU) for non-invasive ventilation. The result of the neurological examination was normal. At day 21, while the patient had been weaned off oxygen, he became unresponsive and rapidly comatose (Glasgow Coma Scale 6: E1, V1, M4) with a disconjugated gaze. The patient was groaning and showing rhythmic movements of the right upper limb. An urgent brain MRI, including diffusion-weighted imaging (DWI) and MR angiogram, ruled out vertebrobasilar ischaemic stroke; gradient echo T2*-weighted images excluded haemorrhage and thrombus in the venous system. It revealed only subtle hyperintensities in bilateral thalami on FLAIR sequence (figure 1). Consciousness impairment required tracheal intubation. He was hyperthermic (39°C) without shock. Blood and cerebrospinal fluid (CSF) samples revealed thrombopenia and lymphopenia, mild inflammatory response (C reactive protein, ferritin and fibrinogen), CSF albumin-cytological dissociation with increased CSF IgG antibodies (91.9 mg/L, normal 10–30 mg/L) and altered blood–brain barrier integrity (CSF/serum albumin index=17.3, normal
Published: 2020

46. Traumatisé crânien au bloc opératoire : hiérarchiser, monitorer ?

Author: Claire Dahyot-Fizelier, Thomas Geeraerts, and Pierre Bouzat
Subjects: 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030208 emergency & critical care medicine, 030217 neurology & neurosurgery
Abstract: Resume La gestion perioperatoire d’un patient polytraumatise cerebrolese repose d’abord sur le diagnostic des lesions necessitant un traitement urgent et la hierarchisation de leur prise en charge. Cette hierarchisation doit tenir compte du type de lesions extra-crâniennes, des consequences cerebrales de leur prise en charge chirurgicale et de la presence ou non d’une hypertension intracrânienne. La priorite de la gestion peroperatoire du polytraumatise cerebrolese est de limiter l’aggravation des lesions cerebrales. Cette prise en charge optimisee passe par le choix adapte des agents anesthesiques, la stabilisation hemodynamique avec le traitement d’un eventuel etat de choc hemorragique et la correction de la coagulopathie associee, le choix d’un monitorage adapte permettant l’adaptation individuelle du debit sanguin cerebral. La prise en charge postoperatoire sera conditionnee par la severite du bilan lesionnel et la presence ou non d’une compliance cerebrale limitee.
Published: 2020
Full Text: View/download PDF

47. L’éducation interprofessionnelle des équipes de soins critiques par la simulation : concept, mise en œuvre et évaluation

Author: Charles-Henri Houze-Cerfon, Michèle Saint-Jean, Sylvain Boet, Thomas Geeraerts, Fouad Marhar, CHU Toulouse [Toulouse], Département des Sciences de l'éducation et de la formation, Université de Tours, Education, Formation, Travail, Savoirs (EFTS), and Université Toulouse - Jean Jaurès (UT2J)-École Nationale Supérieure de Formation de l'Enseignement Agricole de Toulouse-Auzeville (ENSFEA)
Subjects: Medical education, Teamwork, Hierarchy, 020205 medical informatics, business.industry, [SDV]Life Sciences [q-bio], 4. Education, Debriefing, media_common.quotation_subject, 02 engineering and technology, General Medicine, Interprofessional education, Outcome (game theory), 03 medical and health sciences, 0302 clinical medicine, 0202 electrical engineering, electronic engineering, information engineering, Medicine, Interprofessional teamwork, 030212 general & internal medicine, business, Curriculum, Simulation based, ComputingMilieux_MISCELLANEOUS, media_common
Abstract: Interprofessional simulation-based education is effective for learning non-technical critical care skills and strengthening interprofessional team collaboration to optimize quality of care and patient outcome. Implementation of interprofessional simulation sessions in initial and continuing education is facilitated by a team of "champions" from each discipline/profession to ensure educational quality and logistics. Interprofessional simulation training must be integrated into a broader interprofessional curriculum supported by managers, administrators and clinical colleagues from different professional programs. When conducting interprofessional simulation training, it is essential to account for sociological factors (hierarchy, power, authority, interprofessional conflicts, gender, access to information, professional identity) both in scenario design and debriefing. Teamwork assessment tools in interprofessional simulation training may be used to guide debriefing. The interprofessional simulation setting (in-situ or simulation centre) will be chosen according to the learning objectives and the logistics.
Published: 2019
Full Text: View/download PDF

48. 'Real life' impact of anesthesia strategy for mechanical thrombectomy on the delay, recanalization and outcome in acute ischemic stroke patients

Author: Jean-Marc Olivot, Thomas Geeraerts, Caterina Michelozzi, Christophe Cognard, Jean Darcourt, Fabrice Bonneville, Philippe Tall, Ivan Vukasinovic, Ségolène Mrozek, Anne-Christine Januel, and Adrien Guenego
Subjects: Mechanical Thrombolysis, medicine.medical_treatment, Sedation, Conscious Sedation, Anesthesia, General, Revascularization, Brain Ischemia, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Text mining, medicine, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, Stroke, Aged, Radiological and Ultrasound Technology, Groin, business.industry, Mortality rate, Middle Aged, medicine.disease, Mechanical thrombectomy, Treatment Outcome, medicine.anatomical_structure, Anesthesia, Observational study, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery
Abstract: Background and purpose Choice of anesthesia type on outcome for mechanical thrombectomy (MT) in acute ischemic stroke remains controversial. The goal of our research was to study the impact of anesthesia strategy on the delay, angiographic and neurological outcome of MT performed under general anesthesia (GA) vs. conscious sedation (CS). Methods This prospective, single-center observational study included patients with anterior circulation large vessel occlusion (ACLVO) strokes treated with MT within 6 hours of symptom onset. All time metrics were evaluated. Angiographic and clinical outcomes were assessed by recanalization rate (mTICI) and 3-month functional independence (mRs). Complications and mortality rate were recorded as safety outcomes. Results In total, 303 consecutive thrombectomies were performed, 86.8% under GA. NIHSS was higher in GA, with median of 19.0 for GA and 16.5 for CS (P = 0.049). Median time from arrival in hospital (door) to groin puncture was 83 min (IQR = 45.0–109.5) for GA compared to 72 min (IQR = 35.0–85.3) for CS, P = 0.170). Median time from arrival in the angiosuite to groin puncture was 20 min (IQR = 15.0–29.0) for GA compared to 15 min (IQR = 10.0–20.0) for CS, P = 0.017). There were no significant differences in recanalization time metrics, successful revascularization rate, functional independence and mortality rate at three months. Conclusions GA induced a 5 to 10 minutes delay for groin puncture, without impact on recanalization time metrics, or neurological outcome at 3 months. Our results demonstrate that a well-organized workflow is associated with reasonable delay in performing GA for MT, without effect on outcome compared to sedation.
Published: 2019
Full Text: View/download PDF

49. Effects of Resistance Exercise with or without Whey Protein Supplementation on Ocular Changes after a 21-Day Head-Down Bed Rest

Author: Laurence Mahieu, Jean-Claude Quintyn, Marc Kermorgant, Sirine Hammoud, Vincent Soler, Arnaud Beck, Marie-Pierre Bareille, Anne Pavy-Le Traon, and Thomas Geeraerts
Subjects: Applanation tonometry, medicine.medical_specialty, Intraocular pressure, Heel, Nutritional Supplementation, genetic structures, medicine.medical_treatment, Science, Bed rest, Article, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, 0302 clinical medicine, optical coherence tomography, intraocular pressure, head-down bed rest, microgravity, Internal medicine, medicine, Ecology, Evolution, Behavior and Systematics, business.industry, Resistance training, Paleontology, eye diseases, Prolonged exposure, medicine.anatomical_structure, Space and Planetary Science, 030221 ophthalmology & optometry, Cardiology, sense organs, business, 030217 neurology & neurosurgery
Abstract: Neuro-ophthalmological changes have been reported after prolonged exposure to microgravity; however, the pathophysiology remains unclear. The objectives of the present study were twofold: (1) to assess the neuro-ophthalmological impact of 21 days of head-down bed rest (HDBR) and (2) to determine the effects of resistance vibration exercise (RVE) alone or combined with nutritional supplementation (NeX). In this case, 12 healthy male subjects completed three interventions of a 21-day HDBR: a control condition without countermeasure (CON), a condition with resistance vibration exercise (RVE) comprising of squats, single leg heel and bilateral heel raises and a condition using also RVE associated with nutritional supplementation (NeX). Intraocular pressure (IOP) was assessed by applanation tonometry. Retinal nerve fiber layer thickness (RNFLT) was assessed with spectral-domain optical coherence tomography, before HDBR and between Day 2 and Day 4 after each session of HDBR. In CON condition, IOP was preserved; while in RVE and NeX conditions, IOP was increased. In CON condition, RNFLT was preserved after HDBR. RVE and NeX conditions did not have significant effects on RNFLT. This study showed that a 3-week HDBR did not induce significant ophthalmological changes. However, RVE induced an elevation in IOP after HDBR. Nutritional supplementation did not reduce or exacerbate the side effects of RVE.
Published: 2021

50. PF4 Immunoassays in Vaccine-Induced Thrombotic Thrombocytopenia

Author: Alexandra Fournel, Jérôme Rollin, Claire Pouplard, Thomas Geeraerts, Guillaume Mourey, Gilles Pernod, Sophie Susen, Hubert Galinat, Vincent Mémier, Yves Gruel, Caroline Vayne, Olivier Huet, Raphaël Marlu, and Charlotte Cordonnier
Subjects: Laboratory methods, 2019-20 coronavirus outbreak, medicine.diagnostic_test, Coronavirus disease 2019 (COVID-19), business.industry, General Medicine, Heparin, 030204 cardiovascular system & hematology, medicine.disease, Thrombosis, Vaccination, 03 medical and health sciences, 0302 clinical medicine, Immune system, hemic and lymphatic diseases, Immunoassay, Immunology, Correspondence, medicine, 030212 general & internal medicine, business, medicine.drug
Abstract: Laboratory Method to Detect VITT The rare vaccine-induced immune thrombotic thrombocytopenia that may follow adenovirus-based Covid-19 vaccination resembles heparin-induced thrombocytopenia, but ra...
Published: 2021

Catalog

Books, media, physical & digital resources

See catalog results

Searchworks

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

Search

Search Constraints

Refine your results

Search Limiters

Topic

Publication Year Range

Language

Publication Type

Journal

Database

Publisher

234 results on '"Thomas, Geeraerts"'

Search Results

Catalog

Select search scope, currently: Articles

Catalog

books, media & more in Jio Institute collections

Articles

journal articles & other e-resources