المؤلفون: Guilleminot, Pierre, Andrei, Stefan, Nguyen, Maxime, Abou-Arab, Osama, Besnier, Emmanuel, Bouhemad, Belaid, Guinot, Pierre-Grégoire

المصدر: Frontiers in Pharmacology ; volume 15 ; ISSN 1663-9812

الوصف: Objective: We investigated the effects of the maintenance of angiotensin-converting enzyme inhibitors (ACE inhibitors) the day of the surgery on the incidence of postoperative acute kidney injury (AKI) and cardiac events in patients undergoing cardiac surgery. Methods: We performed a multicentric observational study with propensity matching on 1,072 patients treated with ACE inhibitors. We collected their baseline demographic data, comorbidities, and operative and postoperative outcomes. AKI was defined by KDIGO (Kidney Disease: Improving Global Outcome). Results: Maintenance of an ACE inhibitor was not associated with an increased risk of AKI (OR: 1.215 (CI 95% :0.657–2.24), p = 0.843, 71 patients (25.1%) vs. 68 patients (24%)). Multivariate logistic regression and sensitive analysis did not demonstrate any association between ACE inhibitor maintenance and AKI, following cardiac surgery (OR: 1.03 (CI 95% :0.81–1.3)). No statistically significant difference occurs in terms of incidence of cardiogenic shock (OR: 1.315 (CI 95% :0.620–2.786)), stroke (OR: 3.313 (CI 95% :0.356–27.523)), vasoplegia (OR: 0.741 (CI 95% :0.419–1.319)), postoperative atrial fibrillation (OR: 1.710 (CI 95% :0.936–3.122)), or mortality (OR: 2.989 (CI 95% :0.343–26.034)). ICU and hospital length of stays did not differ (3 [2; 5] vs. 3 [2; 5] days, p = 0.963 and 9.5 [8; 12] vs. 10 [8; 14] days, p = 0.638). Conclusion: Our study revealed that maintenance of ACE inhibitors on the day of the surgery was not associated with increased postoperative AKI. ACE inhibitor maintenance was also not associated with an increased rate of postoperative major cardiovascular events (arterial hypotension, cardiogenic shock, vasopressors use, stroke and death).

الإتاحة: https://doi.org/10.3389/fphar.2024.1343647Test

المؤلفون: Demailly, Zoé, Besnier, Emmanuel, Tamion, Fabienne, Lesur, Olivier

المصدر: Frontiers in Cardiovascular Medicine ; volume 10 ; ISSN 2297-055X

مصطلحات موضوعية: Cardiology and Cardiovascular Medicine

الوصف: Sepsis is an archetype of distributive shock and combines different levels of alterations in preload, afterload, and often cardiac contractility. The use of hemodynamic drugs has evolved over the past few years, along with the invasive and non-invasive tools used to measure these components in real time. However, none of them is impeccable, which is why the mortality of septic shock remains too high. The concept of ventriculo-arterial coupling (VAC) allows for the integration of these three fundamental macroscopic hemodynamic components. In this mini review, we discuss the knowledge, tools, and limitations of VAC measurement, along with the evidence supporting ventriculo-arterial uncoupling in septic shock. Finally, the impact of recommended hemodynamic drugs and molecules on VAC is detailed.

الإتاحة: https://doi.org/10.3389/fcvm.2023.1172703Test

المؤلفون: Compère, Vincent, Besnier, Emmanuel, Clavier, Thomas, Byhet, Nicolas, Lefranc, Florent, Jegou, Frederic, Sturzenegger, Nicolas, Hardy, Jean Baptiste, Dureuil, Bertrand, Elie, Thomas

المصدر: Frontiers in Medicine ; volume 8 ; ISSN 2296-858X

مصطلحات موضوعية: General Medicine

الوصف: Background Changes in the health system in Western countries have increased the scope of the daily tasks assigned to physicians', anesthetists included. As already shown in other specialties, increased non-clinical burden reduces the clinical time spent with patients. Methods This was a multicenter, prospective, observational study conducted in 6 public and private hospitals in France. The primary endpoint was the evaluation by an external observer of the time spent per day (in minutes) by anesthetists on clinical tasks in the operating room. Secondary endpoints were the time spent per day (in minutes) on non-clinical organizational tasks and the number of task interruptions per hour of work. Results Between October 2017 and April 2018, 54 anesthetists from six hospitals (1 public university hospital, two public general hospitals and three private hospitals) were included. They were followed for 96 days corresponding to 550 hours of work. The proportion of overall clinical time was 62% (58% 95%CI [53; 63] for direct care. The proportion of organizational time was higher in public hospitals (11% in the university hospital ( p < 0.001) and 4% in general hospitals ( p < 0.01)) compared to private hospitals (1%). The number of task interruptions (1.5/h ± 1.4 in all hospitals) was 4 times higher in the university hospital (2.2/h ± 1.6) compared to private hospitals (0.5/h ± 0.3) ( p < 0.05). Conclusions Most time in the operating room was spent on clinical care with a significant contrast between public and private hospitals for organizational time.

الإتاحة: https://doi.org/10.3389/fmed.2021.768919Test

المؤلفون: Selim, Jean, Selim, Marc, Demailly, Zoé, Wable, Thierry, Clavier, Thomas, Besnier, Emmanuel, Dureuil, Bertrand, Veber, Benoît, Djerada, Zoubir, Compere, Vincent

المصدر: Frontiers in Medicine ; volume 9 ; ISSN 2296-858X

مصطلحات موضوعية: General Medicine

الوصف: Introduction Anesthesia remains a young medical discipline still relatively unknown by the general public and probably by some health professionals. The objective of the study was to evaluate the perception of anesthesiologist by health professionals working with this specialty. Methods We distributed a computerized survey to physicians, residents, paramedical, midwives, and administrative staff in different hospitals between April and July 2018 in Normandy, France. The survey included 38 questions on 6 different topics: communicated image, skills and knowledge, communication, place in patient care, workload, and initial anesthesiologist formation. The survey was validated by a semi-directive interview methodology. A Likert scale from ×2 to +2 (“completely disagree” to “completely agree”) was used for each item. Results Six hundred and twenty five out of 2,000 surveys sent were analyzed. The anesthesiologist conveys an image of serenity (+0.94 ± 0.79), has a high degree of responsibility (+1.72 ± 0.59) with important decision-making power (+1.39 ± 0.82). He guarantees patient safety and comfort (+1.07 ± 0.88) with his/her dual competence in anesthesia and intensive care (+1.36 ± 0.82). Anesthesiology requires teamwork (+1.68 ± 0.58) and good communication skills (+1.48 ± 0.73). The anesthesiologist is not perceived as a service provider (−0.33 ± 1.15) but is the physician responsible for perioperative care (+1.69 ± 1.00). His/her workload is moderately perceived as high (+0.71 ± 1.17) but is confronted with potentially conflictual relationships with colleagues from other specialties (+1.40 ± 0.68) and stressful situations (+1.44 ± 0.80). Conclusion The overall perception of the anesthesiologist in our study appears to be good.

الإتاحة: https://doi.org/10.3389/fmed.2022.852888Test

المؤلفون: Clavier, Thomas, Demailly, Zoé, Semaille, Xavier, Thill, Caroline, Selim, Jean, Veber, Benoit, Doguet, Fabien, Richard, Vincent, Besnier, Emmanuel, Tamion, Fabienne

المصدر: Frontiers in Medicine ; volume 7 ; ISSN 2296-858X

مصطلحات موضوعية: General Medicine

الوصف: Introduction: Endoplasmic reticulum stress (ERS) is involved in inflammatory organ failure. Our objective was to describe ERS, its unfolded protein response (UPR) expression/kinetics during cardiac surgery with cardiopulmonary bypass (CPB) and its association with postoperative organ failure (OF). Methods: Prospective study conducted on patients undergoing cardiac surgery with CPB. Blood samples were taken before (Pre-CPB), 2 h (H2-CPB) and 24 h (H24-CPB) after CPB. Plasma levels of 78 kDa Glucose- Regulated Protein (GRP78, final effector of UPR) were evaluated by ELISA. The expression of genes coding for key elements of UPR ( ATF6, ATF4, sXBP1, CHOP ) was evaluated by quantitative PCR performed on total blood. OF was defined as invasive mechanical ventilation and/or acute kidney injury and/or hemodynamic failure requiring catecholamines. Results: We included 46 patients, GRP78 was decreased at H2-CPB [1,328 (878–1,730) ng/ml vs. 2,348 (1,655–3,730) ng/ml Pre-CPB; p < 0.001] but returned to basal levels at H24-CPB [2,068 (1,436–3,005) ng/ml]. The genes involved in UPR had increased expression at H2 and H24. GRP78 plasma levels in patients with OF at H24-CPB ( n = 10) remained below Pre-CPB levels [−27.6 (−51.5; −24.2)%] compared to patients without OF ( n = 36) in whom GRP78 levels returned to basal levels [0.6 (−28.1; 26.6)%; p < 0.01]. H24-CPB ATF6 and CHOP expressions were lower in patients with OF than in patients without OF [2.3 (1.3–3.1) vs. 3.0 (2.7–3.7), p < 0.05 and 1.3 (0.9–2.0) vs. 2.2 (1.7–2.9), p < 0.05, respectively]. Conclusions: Low relative levels of GRP78 and weak UPR gene expression appeared associated with postoperative OF. Further studies are needed to understand ERS implication during acute organ failure in humans.

الإتاحة: https://doi.org/10.3389/fmed.2020.613518Test

المؤلفون: Clavier, Thomas, Grangé, Steven, Pressat-Laffouilhere, Thibaut, Besnier, Emmanuel, Renet, Sylvanie, Fraineau, Sylvain, Thiebaut, Pierre-Alain, Richard, Vincent, Veber, Benoit, Tamion, Fabienne

المصدر: Frontiers in Medicine ; volume 6 ; ISSN 2296-858X

الإتاحة: https://doi.org/10.3389/fmed.2019.00240Test