المؤلفون: Gaudry, Stephane, Hajage, David, Schortgen, Frederique, Martin-Lefevre, Laurent, Verney, Charles, Pons, Bertrand, Boulet, Eric, Boyer, Alexandre, Chevrel, Guillaume, Lerolle, Nicolas, Carpentier, Dorothee, De Prost, Nicolas, Lautrette, Alexandre, Bretagnol, Anne, Mayaux, Julien, Nseir, Saad, Megarbane, Bruno, Thirion, Marina, Forel, Jean-Marie, Maizel, Julien, Yonis, Hodane, Markowicz, Philippe, Thiery, Guillaume, Tubach, Florence, Ricard, Jean-Damien, Dreyfuss, Didier

المساهمون: Inserm, Université de Lille, CHU Lille, Lille Inflammation Research International Center (LIRIC) - U995, Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables ECEVE (U1123 / UMR_S_1123), Université d'Angers UA, Université Paris-Est Créteil Val-de-Marne - Paris 12 UPEC UP12, Lille Inflammation Research International Center - U 995 LIRIC, Université Paris Diderot - Paris 7 UPD7, Université Pierre et Marie Curie - Paris 6 UPMC

مصطلحات موضوعية: renal replacement therapy, acute kidney injury, acute respiratory distress syndrome, mechanical ventilation, septic shock

الوصف: Rationale: The optimal strategy for initiation of renal replacement therapy (RRT) in patients with severe acute kidney injury in the context of septic shock and acute respiratory distress syndrome (ARDS) is unknown. Objectives: To examine the effect of an early compared with a delayed RRT initiation strategy on 60-day mortality according to baseline sepsis status, ARDS status, and severity. Methods: Post hoc analysis of the AKIKI (Artificial Kidney Initiation in Kidney Injury) trial. Measurements and Main Results: Subgroups were defined according to baseline characteristics: sepsis status (Sepsis-3 definition), ARDS status (Berlin definition), Simplified Acute Physiology Score 3 (SAPS 3), and Sepsis-related Organ Failure Assessment (SOFA). Of 619 patients, 348 (56%) had septic shock and 207 (33%) had ARDS. We found no significant influence of the baseline sepsis status (P = 0.28), baseline ARDS status (P = 0.94), and baseline severity scores (P = 0.77 and P = 0.46 for SAPS 3 and SOFA, respectively) on the comparison of 60-day mortality according to RRT initiation strategy. A delayed RRT initiation strategy allowed 45% of patients with septic shock and 46% of patients with ARDS to escape RRT. Urine output was higher in the delayed group. Renal function recovery occurred earlier with the delayed RRT strategy in patients with septic shock or ARDS (P < 0.001 and P = 0.003, respectively). Time to successful extubation in patients with ARDS was not affected by RRT strategy (P = 0.43). Conclusions: Early RRT initiation strategy was not associated with any improvement of 60-day mortality in patients with severe acute kidney injury and septic shock or ARDS. Unnecessary and potentially risky procedures might often be avoided in these fragile populations. ; 198

العلاقة: American Journal of Respiratory and Critical Care Medicine; Am. J. Respir. Crit. Care Med.; http://hdl.handle.net/20.500.12210/5087Test

الإتاحة: https://doi.org/20.500.12210/5087Test
https://hdl.handle.net/20.500.12210/5087Test

المؤلفون: Rouzé, Anahita, Lemaitre, Elise, Martin-Loeches, Ignacio, Povoa, Pedro, Diaz, Emili, Nyga, Rémy, Torres, Antoni, Metzelard, Matthieu, Du Cheyron, Damien, Lambiotte, Fabien, Tamion, Fabienne, Labruyere, Marie, Boulle Geronimi, Claire, Luyt, Charles-Edouard, Nyunga, Martine, Pouly, Olivier, Thille, Arnaud, Megarbane, Bruno, Saade, Anastasia, Magira, Eleni, Llitjos, Jean-François, Ioannidou, Iliana, Pierre, Alexandre, Reignier, Jean, Garot, Denis, Kreitmann, Louis, Baudel, Jean-Luc, Voiriot, Guillaume, Plantefeve, Gaëtan, Morawiec, Elise, Asfar, Pierre, Boyer, Alexandre, Mekontso-Dessap, Armand, Makris, Demosthenes, Vinsonneau, Christophe, Floch, Pierre-Edouard, Marois, Clémence, Ceccato, Adrian, Artigas, Antonio, Gaudet, Alexandre, Nora, David, Cornu, Marjorie, Duhamel, Alain, Labreuche, Julien, Nseir, Saad

المساهمون: Unité de Glycobiologie Structurale et Fonctionnelle - UMR 8576 UGSF, CHU Amiens-Picardie, Centre hospitalier Valenciennes, Nord, Endothélium, valvulopathies et insuffisance cardiaque EnVI, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand CHU Dijon, Centre Hospitalier Douai, Nord, CIC - Poitiers, Optimisation thérapeutique en Neuropsychopharmacologie OPTeN (UMR_S_1144 / U1144), Service de Réanimation Médicale et Toxicologique Hôpital Lariboisière, Hopital Saint-Louis AP-HP AP-HP, Hôpital Cochin AP-HP, Centre Hospitalier de Lens, Centre hospitalier universitaire de Nantes CHU Nantes, Hôpital Bretonneau, CHU Saint-Antoine AP-HP, CHU Tenon AP-HP, Centre Hospitalier Victor Dupouy, CHU Pitié-Salpêtrière AP-HP, Neurophysiologie Respiratoire Expérimentale et Clinique UMRS 1158, Centre Hospitalier Universitaire d'Angers CHU Angers, CHU Bordeaux Bordeaux, Groupe de recherche clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis) CARMAS, Institut Mondor de Recherche Biomédicale IMRB, Centre de Recherche Saint-Antoine CRSA, Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 CIIL

مصطلحات موضوعية: COVID-19, Intensive care unit, Invasive pulmonary aspergillosis, Mechanical ventilation, Severe influenza

الوصف: Background Recent multicenter studies identified COVID-19 as a risk factor for invasive pulmonary aspergillosis (IPA). However, no large multicenter study has compared the incidence of IPA between COVID-19 and influenza patients. Objectives To determine the incidence of putative IPA in critically ill SARS-CoV-2 patients, compared with influenza patients. Methods This study was a planned ancillary analysis of the coVAPid multicenter retrospective European cohort. Consecutive adult patients requiring invasive mechanical ventilation for > 48 h for SARS-CoV-2 pneumonia or influenza pneumonia were included. The 28-day cumulative incidence of putative IPA, based on Blot definition, was the primary outcome. IPA incidence was estimated using the Kalbfleisch and Prentice method, considering extubation (dead or alive) within 28 days as competing event. Results A total of 1047 patients were included (566 in the SARS-CoV-2 group and 481 in the influenza group). The incidence of putative IPA was lower in SARS-CoV-2 pneumonia group (14, 2.5%) than in influenza pneumonia group (29, 6%), adjusted cause-specific hazard ratio (cHR) 3.29 (95% CI 1.53–7.02, p = 0.0006). When putative IPA and Aspergillus respiratory tract colonization were combined, the incidence was also significantly lower in the SARS-CoV-2 group, as compared to influenza group (4.1% vs. 10.2%), adjusted cHR 3.21 (95% CI 1.88–5.46, p < 0.0001). In the whole study population, putative IPA was associated with significant increase in 28-day mortality rate, and length of ICU stay, compared with colonized patients, or those with no IPA or Aspergillus colonization. Conclusions Overall, the incidence of putative IPA was low. Its incidence was significantly lower in patients with SARS-CoV-2 pneumonia than in those with influenza pneumonia. Clinical trial registration The study was registered at ClinicalTrials.gov, number NCT04359693 . ; 26 ; 1

وصف الملف: application/octet-stream

العلاقة: Critical Care; http://hdl.handle.net/20.500.12210/78541Test

الإتاحة: https://doi.org/20.500.12210/78541Test
https://hdl.handle.net/20.500.12210/78541Test