يعرض 1 - 10 نتائج من 91 نتيجة بحث عن '"Lehingue, Samuel"', وقت الاستعلام: 1.51s تنقيح النتائج
  1. 1
    دورية أكاديمية

    المساهمون: Université de Lille, CNRS, Unité de Glycobiologie Structurale et Fonctionnelle (UGSF) - UMR 8576

    الوصف: Background Critically ill patients with obesity may have an increased risk of difficult intubation and subsequent severe hypoxemia. We hypothesized that pre-oxygenation with noninvasive ventilation before intubation as compared with high-flow nasal cannula oxygen may decrease the risk of severe hypoxemia in patients with obesity. Methods Post hoc subgroup analysis of critically ill patients with obesity (body mass index ≥ 30 kg·m−2) from a multicenter randomized controlled trial comparing preoxygenation with noninvasive ventilation and high-flow nasal oxygen before intubation of patients with acute hypoxemic respiratory failure (PaO2/FiO2 < 300 mm Hg). The primary outcome was the occurrence of severe hypoxemia (pulse oximetry < 80%) during the intubation procedure. Results Among the 313 patients included in the original trial, 91 (29%) had obesity with a mean body mass index of 35 ± 5 kg·m−2. Patients with obesity were more likely to experience an episode of severe hypoxemia during intubation procedure than patients without obesity: 34% (31/91) vs. 22% (49/222); difference, 12%; 95% CI 1 to 23%; P = 0.03. Among patients with obesity, 40 received preoxygenation with noninvasive ventilation and 51 with high-flow nasal oxygen. Severe hypoxemia occurred in 15 patients (37%) with noninvasive ventilation and 16 patients (31%) with high-flow nasal oxygen (difference, 6%; 95% CI − 13 to 25%; P = 0.54). The lowest pulse oximetry values during intubation procedure were 87% [interquartile range, 77–93] with noninvasive ventilation and 86% [78–92] with high-flow nasal oxygen (P = 0.98). After multivariable analysis, factors independently associated with severe hypoxemia in patients with obesity were intubation difficulty scale > 5 points and respiratory primary failure as reason for admission. Conclusions Patients with obesity and acute hypoxemic respiratory failure had an increased risk of severe hypoxemia during intubation procedure as compared to patients without obesity. However, preoxygenation with noninvasive ...

    وصف الملف: application/rdf+xml; charset=utf-8; application/octet-stream

    العلاقة: Annals of Intensive Care; Ann. Intensive Care; http://hdl.handle.net/20.500.12210/107894Test

  2. 2
    دورية أكاديمية

    المساهمون: Hôpital de la Timone CHU - APHM (TIMONE), Centre d'Immunologie de Marseille - Luminy (CIML), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Nouvel Hôpital Civil de Strasbourg, Les Hôpitaux Universitaires de Strasbourg (HUS), Hôpital l'Archet, Réanimation Polyvalente, HIA Laveran - Department of Intensive Care - Marseille, Hôpital Européen Fondation Ambroise Paré - Marseille, Centre Hospitalier Victor Dupouy, Aix Marseille Université (AMU), Institut de Neurosciences de la Timone (INT), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Nîmes University Hospital, Department of Intensive Care, Hôpital Saint-Joseph Marseille, Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Centre Hospitalier Régional d'Orléans (CHRO), Hôpital Saint-André, Université de Bordeaux (UB), Innate Pharma, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), HIA Laveran a Marseille, European Project: 694502,H2020-EU.1.1. - EXCELLENT SCIENCE - European Research Council (ERC) ,TILC(2017), European Project: 875102,MInflaTILC

    المصدر: ISSN: 0090-3493.

    الوصف: International audience ; OBJECTIVES: Severe COVID-19 is associated with exaggerated complement activation. We assessed the efficacy and safety of avdoralimab (an anti-C5aR1 mAb) in severe COVID-19. DESIGN: FOR COVID Elimination (FORCE) was a double-blind, placebo-controlled study. SETTING: Twelve clinical sites in France (ICU and general hospitals). PATIENTS: Patients receiving greater than or equal to 5 L oxygen/min to maintain Spo 2 greater than 93% (World Health Organization scale ≥ 5). Patients received conventional oxygen therapy or high-flow oxygen (HFO)/noninvasive ventilation (NIV) in cohort 1; HFO, NIV, or invasive mechanical ventilation (IMV) in cohort 2; and IMV in cohort 3. INTERVENTIONS: Patients were randomly assigned, in a 1:1 ratio, to receive avdoralimab or placebo. The primary outcome was clinical status on the World Health Organization ordinal scale at days 14 and 28 for cohorts 1 and 3, and the number of ventilator-free days at day 28 (VFD28) for cohort 2. MEASUREMENTS AND MAIN RESULTS: We randomized 207 patients: 99 in cohort 1, 49 in cohort 2, and 59 in cohort 3. During hospitalization, 95% of patients received glucocorticoids. Avdoralimab did not improve World Health Organization clinical scale score on days 14 and 28 (between-group difference on day 28 of-0.26 (95% CI,-1.2 to 0.7; p = 0.7) in cohort 1 and-0.28 (95% CI,-1.8 to 1.2; p = 0.6) in cohort 3). Avdoralimab did not improve VFD28 in cohort 2 (between-group difference of-6.3 (95% CI,-13.2 to 0.7; p = 0.96) or secondary outcomes in any cohort. No subgroup of interest was identified. CONCLUSIONS: In this randomized trial in hospitalized patients with severe COVID-19 pneumonia, avdoralimab did not significantly improve clinical status at days 14 and 28 (funded by Innate Pharma, ClinicalTrials.gov number, NCT04371367).

    العلاقة: info:eu-repo/grantAgreement//694502/EU/Targeting Innate Lymphoid Cells/TILC; info:eu-repo/grantAgreement//875102/EU/Generation of therapeutic antibodies targeting type 2 Innate Lymphoid cells in asthma/MInflaTILC; hal-03952765; https://amu.hal.science/hal-03952765Test; https://amu.hal.science/hal-03952765/documentTest; https://amu.hal.science/hal-03952765/file/ccm-50-1788.pdfTest

  3. 3
    دورية أكاديمية

    المصدر: Critical Care Explorations ; volume 4, issue 12, page e0805 ; ISSN 2639-8028

    الوصف: OBJECTIVES: To determine the effect of the awake prone position (APP) on gas exchange and the work of breathing in spontaneously breathing patients with COVID-19–associated acute hypoxemic respiratory failure (AHRF) supported by high-flow nasal oxygen. DESIGN: Prospective randomized physiologic crossover multicenter trial. SETTINGS: Four ICUs in Marseille, France. PATIENTS: Seventeen patients with laboratory-confirmed COVID-19 pneumonia and Pa o 2 /F io 2 less than or equal to 300 mm Hg while treated with high-flow nasal cannula oxygen therapy. INTERVENTIONS: Periods of APP and semirecumbent position (SRP) were randomly applied for 2 hours and separated by a 2-hour washout period. MEASUREMENTS AND MAIN RESULTS: Arterial blood gases, end-tidal CO 2 . and esophageal pressure were recorded prior to and at the end of each period. Inspiratory muscle effort was assessed by measuring the esophageal pressure swing (∆P ES ) and the simplified esophageal pressure–time product (sPTP ES ). The other endpoints included physiologic dead space to tidal volume ratio (V D /V T ) and the transpulmonary pressure swing. The APP increased the Pa o 2 /F io 2 from 84 Torr (61–137 Torr) to 208 Torr (114–226 Torr) ( p = 0.0007) and decreased both the V D /V T and the respiratory rate from 0.54 (0.47–0.57) to 0.49 (0.45–0.53) ( p = 0.012) and from 26 breaths/min (21–30 breaths/min) to 21 breaths/min (19–22 breaths/min), respectively ( p = 0.002). These variables remained unchanged during the SRP. The ∆P ES and sPTP ES per breath were unaffected by the position. However, the APP reduced the sPTP ES per minute from 225 cm H 2 O.s.m –1 (176–332 cm H 2 O.s.m –1 ) to 174 cm H 2 O.s.m –1 (161–254 cm H 2 O.s.m –1 ) ( p = 0.049). CONCLUSIONS: In spontaneously breathing patients with COVID-19–associated AHRF supported by high-flow nasal oxygen, the APP improves oxygenation and reduces the physiologic dead space, respiratory rate, and work of breathing per minute.

  4. 4
    دورية أكاديمية

    المساهمون: Ministère de l’Enseignement Supérieur, de la Recherche Scientifique et des Technologies de l'Information et de la Communication

    المصدر: Annals of Intensive Care ; volume 11, issue 1 ; ISSN 2110-5820

    مصطلحات موضوعية: Critical Care and Intensive Care Medicine

    الوصف: Background Critically ill patients with obesity may have an increased risk of difficult intubation and subsequent severe hypoxemia. We hypothesized that pre-oxygenation with noninvasive ventilation before intubation as compared with high-flow nasal cannula oxygen may decrease the risk of severe hypoxemia in patients with obesity. Methods Post hoc subgroup analysis of critically ill patients with obesity (body mass index ≥ 30 kg·m −2 ) from a multicenter randomized controlled trial comparing preoxygenation with noninvasive ventilation and high-flow nasal oxygen before intubation of patients with acute hypoxemic respiratory failure (PaO 2 /FiO 2 < 300 mm Hg). The primary outcome was the occurrence of severe hypoxemia (pulse oximetry < 80%) during the intubation procedure. Results Among the 313 patients included in the original trial, 91 (29%) had obesity with a mean body mass index of 35 ± 5 kg·m −2 . Patients with obesity were more likely to experience an episode of severe hypoxemia during intubation procedure than patients without obesity: 34% (31/91) vs. 22% (49/222); difference, 12%; 95% CI 1 to 23%; P = 0.03. Among patients with obesity, 40 received preoxygenation with noninvasive ventilation and 51 with high-flow nasal oxygen. Severe hypoxemia occurred in 15 patients (37%) with noninvasive ventilation and 16 patients (31%) with high-flow nasal oxygen (difference, 6%; 95% CI − 13 to 25%; P = 0.54). The lowest pulse oximetry values during intubation procedure were 87% [interquartile range, 77–93] with noninvasive ventilation and 86% [78–92] with high-flow nasal oxygen ( P = 0.98). After multivariable analysis, factors independently associated with severe hypoxemia in patients with obesity were intubation difficulty scale > 5 points and respiratory primary failure as reason for admission. Conclusions Patients with obesity and acute hypoxemic respiratory failure had an increased risk of severe hypoxemia during intubation procedure as compared to patients without obesity. However, preoxygenation ...

  5. 5
    دورية أكاديمية
  6. 6
    دورية أكاديمية

    المصدر: Antimicrobial Resistance & Infection Control ; volume 9, issue 1 ; ISSN 2047-2994

    الوصف: Background Appropriate hand hygiene (HH) is key to reducing healthcare-acquired infections. The World Health Organization (WHO) recommends education and training to improve HH knowledge and compliance. Physicians are ranked among the worst of all healthcare workers for compliant handrubbing with its origin probably being the failure to learn this essential behavior during undergraduate medical studies. This study evaluated if the use of Ultraviolet-cabinets (UVc) for fluorescent-alcohol-based handrubs (AHR) during an undergraduate medical student training improved the compliance rate to the WHO hand hygiene recommendations (completeness of AHR application and HH opportunities). Methods This randomized trial compared a HH training with personal feedback (using UVc) to a control group. The first year, the students (2nd degree) were convened by groups (clusters) of 6–9 for a demonstration of the correct execution of WHO procedure. Randomization by cluster was done prior HH training. In the control group, the students hand rubbed under visual supervision of a tutor. In the intervention group after the same visual supervision, completeness of fluorescent-AHR hand application was recorded under UVc and was shown to the student. The intervention group had free access to the UVc until complete application. HH practices were included in simulation sessions for the both groups. One year after (3rd degree), all the students were asked to hand rub with fluorescent-AHR. A tutor (blinded to the study group) assessed the completeness of hand application under UVc and the compliance with the WHO opportunities. Complete application of AHR was defined as fluorescence for all the surfaces of hands and wrists. Results 242 students participated (140 in the intervention group and 102 in the control group). One year after the initial training, the rate of complete application of AHR was doubled in the intervention group (60.0% vs. 30.4%, p < 0.001). In a multivariate analysis which included gender, additional HH or UVc ...

  7. 7
    دورية أكاديمية

    المساهمون: Service de réanimation-Détresses Respiratoires et Infections Sévères Hôpital Nord - APHM (DRIS), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital Nord CHU - APHM, Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université (AMU), Service de Santé Publique et d'Information Médicale (SSPIM), Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Timone CHU - APHM (TIMONE), Service des Maladies Infectieuses et Tropicales CHU Hôpital Nord - Marseille (M.I.T), Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital Nord CHU - APHM, Institut Hospitalier Universitaire Méditerranée Infection (IHU Marseille), Service de Réanimation des Urgences, Assistance Publique - Hôpitaux de Marseille (APHM), Hôpital de la Timone CHU - APHM (TIMONE), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Centre de néphrologie et transplantation rénale Hôpital de la Conception - APHM, Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception CHU - APHM (LA CONCEPTION), Hôpital Nord CHU - APHM

    المصدر: ISSN: 0196-6553 ; American Journal of Infection Control ; https://amu.hal.science/hal-02159275Test ; American Journal of Infection Control, 2019, ⟨10.1016/j.ajic.2019.02.030⟩.

    الوصف: International audience ; Background: The link between bacterial resistance and prognosis remains controversial. Predominant pathogen causing ventilator-associated pneumonia (VAP) is Pseudomonas aeruginosa (Pa), which has increasingly become multidrug resistant (MDR). The aim of this study was to evaluate the relationship between MDR VAP Pa episodes and 30-day mortality. Methods: From a longitudinal prospective French multicenter database (2010-2016), Pa VAP onset and physiological data were recorded. MDR was defined as non-susceptibility to at least 1 agent in 3 or more antimi-crobial categories. To analyze if MDR episodes were associated with greater in-hospital 30-day mortality, we performed a multivariate survival analysis using the multivariate nonlinear frailty model. Results: A total of 230 patients presented 286 Pa VAP. A maximum of 3 episodes per patient was observed; 73 episodes were MDR and 213 were susceptible. In the multivariate model, factors independently associated with 30-day mortality included hospitalization in the 6 months preceding the first episode (hazard ratio [HR], 2.31; 95% confidence interval [CI], 1.50-3.60; P = .0002), chronic renal failure (HR, 2.34; 95% CI, 1.15-4.77; P = .0196), and Pa VAP recurrence (HR, 2.29; 95% CI, 1.79-4.87; P = .032). Finally, MDR Pa VAP was not associated with death (HR, 0.87; 95% CI; 0.52-1.45; P = .59). Conclusions: This study did not identify a relationship between the resistance profile of Pseudomonas aerugi-nosa and mortality.

  8. 8
    دورية أكاديمية

    المصدر: Anesthesia & Analgesia ; volume 129, issue 2, page e48-e51 ; ISSN 0003-2999

    الوصف: This single-center case series investigated the effect of almitrine infusion on Pa o 2 /fraction of inspired oxygen (F io 2 ) in 25 patients on veno-venous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. A positive trial was defined as an increase of Pa o 2 /F io 2 ratio ≥20%. Thirty-two trials were performed. Twenty (62.5%, 95% confidence interval, 37.5%–75%) trials in 18 patients were positive, with a median Pa o 2 /F io 2 ratio increase of 35% (25%–43%). A focal acute respiratory distress syndrome and inhaled nitric oxide therapy were more frequent in patients with a positive response to almitrine. We observed no complications of almitrine use.

  9. 9
    دورية أكاديمية

    المصدر: The Lancet Respiratory Medicine ; volume 7, issue 4, page 303-312 ; ISSN 2213-2600

    مصطلحات موضوعية: Pulmonary and Respiratory Medicine

  10. 10
    دورية أكاديمية