المؤلفون: Nesseler, Nicolas, Mansour, Alexandre, Schmidt, Matthieu, Para, Marylou, Porto, Alizée, Falcoz, Pierre-Emmanuel, Mongardon, Nicolas, Fougerou, Claire, Ross, James, Beurton, Antoine, Gaide-Chevronnay, Lucie, Guinot, Pierre-Grégoire, Lebreton, Guillaume, Flecher, Erwan, Vincentelli, André, Massart, Nicolas, Fouquet, Olivier, Pierrot, Marc, Chocron, Sidney, Flicoteaux, Guillaume, Mauriat, Philippe, Ouattara, Alexandre, Roze, Hadrien, Huet, Olivier, Fischer, Marc-Olivier, Bellaïche, Raphel, Constant, Ophélie, de Roux, Quentin, André, L., Meffert, Arnaud, Merle, Jean-Claude, Picard, Lucile, Skripkina, Elena, Folliguet, Thierry, Fiore, Antonio, D’ostrevy, Nicolas, Morgan, Marie-Catherine, Nguyen, Maxime, Terzi, Nicolas, Colin, Gwenhaël, Fabre, Olivier, Astaneh, Arash, Issard, Justin, Fadel, Elie, Fabre, Dominique, Guihaire, Julien, Ion, Iolande, Menager, Jean Baptiste, Mitilian, Delphine, Mercier, Olaf, Stephan, François, Thes, Jacques, Jouan, Jerôme, Duburcq, Thibault, Loobuyck, Valentin, Moussa, Mouhammed, Manganiello, Sabrina, Mugnier, Agnes, Rousse, Natacha, Desebbe, Olivier, Fellahi, Jean-Luc, Henaine, Roland, Pozzi, Matteo, Riad, Zakaria, Guervilly, Christophe, Hraiech, Sami, Papazian, Laurent, Castanier, Matthias, Chanavaz, Charles, Cadoz, Cyril, Gette, Sebastien, Louis, Guillaume, Portocarrero, Erick, Gaudard, Philippe, Brini, Kais, Bischoff, Nicolas, Kimmoun, Antoine, Levy, Bruno, Perez, Pierre, Bourdiol, Alexandre, Hourmant, Yannick, Mahé, Pierre-Joachim, Rozec, Bertrand, Vourc’h, Mickaël, Aubert, Stéphane, Bazalgette, Florian, Roger, Claire, Jaquet, Pierre, Lortat-Jacob, Brice, Mordant, Pierre, Nataf, Patrick, Patrier, Juliette, Provenchere, Sophie, Roué, Morgan, Sonneville, Romain, Tran-Dinh, Alexy, Wicky, Paul-Henri, Al Zreibi, Charles, Cholley, Bernard, Guyonvarch, Yannis, Hamada, Sophie, Barbanti, Claudio, Bertier, Astrid, Harrois, Anatole, Matiello, Jordi, Kerforne, Thomas, Lacroix, Corentin, Brechot, Nicolas, Combes, Alain, Chommeloux, Juliette, D’alessandro, Cosimo, Demondion, Pierre, Demoule, Alexandre, Dres, Martin, Fadel, Guillaume, Fartoukh, Muriel, Hekimian, Guillaume, Juvin, Charles, Leprince, Pascal, Levy, David, Luyt, Charles Edouard, Schoell, Thibaut, Fillâtre, Pierre, Jonas, Maud, Allou, Nicolas, Muccio, Salvatore, Di Perna, Dario, Ruggieri, Vito-Giovanni, Mourvillier, Bruno, Anselmi, Amedeo, Bounader, Karl, Launey, Yoann, Lebouvier, Thomas, Parasido, Alessandro, Reizine, Florian, Esvan, Maxime, Seguin, Philippe, Besnier, Emmanuel, Carpentier, Dorothée, Clavier, Thomas, Olland, Anne, Villard, Marion, Bounes, Fanny, Labaste, François, Minville, Vincent, Guillon, Antoine, Fedun, Yannick

المساهمون: Centre Hospitalier Universitaire de Rennes CHU Rennes = Rennes University Hospital Ponchaillou, Centre d'Investigation Clinique Rennes (CIC), Université de Rennes (UR)-Centre Hospitalier Universitaire de Rennes CHU Rennes = Rennes University Hospital Ponchaillou -Institut National de la Santé et de la Recherche Médicale (INSERM), Nutrition, Métabolismes et Cancer (NuMeCan), 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), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique EHESP (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition CHU Pitié Salpêtrière (IHU ICAN), CHU Pitié-Salpêtrière AP-HP, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière AP-HP, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Assistance Publique - Hôpitaux de Marseille (APHM), Nanomédecine Régénérative (NanoRegMed), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Case Western Reserve University Cleveland, 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), Centre Hospitalier Universitaire CHU Grenoble (CHUGA), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U1011 (RNMCD), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille), Centre hospitalier Saint-Brieuc, This work was supported by a grant from the university hospital of Rennes (Appel à projets CFTR2) and by a grant from the French society of thoracic and cardio-vascular surgery (Société française de chirurgie thoracique et cardio-vasculaire, Bourse Marc Laskar).

المصدر: ISSN: 1364-8535.

مصطلحات موضوعية: Bloodstream infections, ECLS, Nosocomial infections, SARS-CoV 2, Ventilator-associated pneumonia, MESH: Humans, MESH: COVID-19, MESH: Cohort Studies, MESH: Extracorporeal Membrane Oxygenation, MESH: Cross Infection, MESH: Pneumonia, Ventilator-Associated, MESH: Sepsis, MESH: Delivery of Health Care, MESH: Retrospective Studies, [SDV.IB]Life Sciences [q-bio]/Bioengineering

الوصف: International audience ; Background Both critically ill patients with coronavirus disease 2019 (COVID-19) and patients receiving extracorporeal membrane oxygenation (ECMO) support exhibit a high incidence of healthcare-associated infections (HAI). However, data on incidence, microbiology, resistance patterns, and the impact of HAI on outcomes in patients receiving ECMO for severe COVID-19 remain limited. We aimed to report HAI incidence and microbiology in patients receiving ECMO for severe COVID-19 and to evaluate the impact of ECMO-associated infections (ECMO-AI) on in-hospital mortality. Methods For this study, we analyzed data from 701 patients included in the ECMOSARS registry which included COVID-19 patients supported by ECMO in France. Results Among 602 analyzed patients for whom HAI and hospital mortality data were available, 214 (36%) had ECMO-AI, resulting in an incidence rate of 27 ECMO-AI per 1000 ECMO days at risk. Of these, 154 patients had bloodstream infection (BSI) and 117 patients had ventilator-associated pneumonia (VAP). The responsible microorganisms were Enterobacteriaceae (34% for BSI and 48% for VAP), Enterococcus species (25% and 6%, respectively) and non-fermenting Gram-negative bacilli (13% and 20%, respectively). Fungal infections were also observed (10% for BSI and 3% for VAP), as were multidrug-resistant organisms (21% and 15%, respectively). Using a Cox multistate model, ECMO-AI were not found associated with hospital death (HR = 1.00 95% CI [0.79–1.26], p = 0.986). Conclusions In a nationwide cohort of COVID-19 patients receiving ECMO support, we observed a high incidence of ECMO-AI. ECMO-AI were not found associated with hospital death. Trial registration number NCT04397588 (May 21, 2020).

العلاقة: info:eu-repo/semantics/altIdentifier/pmid/38374103; hal-04477794; https://univ-rennes.hal.science/hal-04477794Test; https://univ-rennes.hal.science/hal-04477794/documentTest; https://univ-rennes.hal.science/hal-04477794/file/13054_2024_Article_4832.pdfTest; PUBMED: 38374103; PUBMEDCENTRAL: PMC10877839

الإتاحة: https://doi.org/10.1186/s13054-024-04832-3Test
https://univ-rennes.hal.science/hal-04477794Test
https://univ-rennes.hal.science/hal-04477794/documentTest
https://univ-rennes.hal.science/hal-04477794/file/13054_2024_Article_4832.pdfTest

المؤلفون: BEURTON, Antoine, MICHOT, Maxime, HERION, Francois-Xavier, RIENZO, Mario, ODDOS, Claire, COUFFINHAL, Thierry, IMBAULT, Julien, OUATTARA, Alexandre

مصطلحات موضوعية: article clinique, Humans, Shock, Cardiogenic, Extracorporeal Membrane Oxygenation, Hemodynamics, Myocardium, Signal Transduction, Sciences du Vivant [q-bio]/Médecine humaine et pathologie

الوصف: Peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly being used in patients suffering from refractory cardiogenic shock (CS). Although considered life-saving, peripheral VA-ECMO may also be responsible for intracardiac hemodynamic changes, including left ventricular overload and dysfunction. Venoarterial extracorporeal membrane oxygenation may also increase myocardial wall stress and stroke work, possibly affecting the cellular cardioprotective and apoptosis signaling pathways, and thus the infarct size. To test this hypothesis, we investigated the effects of increasing the peripheral VA-ECMO blood flow (25-100% of the baseline cardiac output) on systemic and cardiac hemodynamics in a closed-chest CS model. Upon completion of the experiment, the hearts were removed for assessment of infarct size, histology, apoptosis measurements, and phosphorylation statuses of p38 and protein Kinase B (Akt), and extracellular signal-regulated kinase mitogen-activated protein kinases (ERK-MAPK). Peripheral VA-ECMO restored systemic perfusion but induced a significant and blood flow-dependent increase in left ventricular preload and afterload. Venoarterial extracorporeal membrane oxygenation did not affect infarct size but significantly decreased p38-MAPK phosphorylation and cardiac myocyte apoptosis in the border zone.

العلاقة: https://oskar-bordeaux.fr/handle/20.500.12278/188686Test

الإتاحة: https://doi.org/20.500.12278/188686Test
https://doi.org/10.1097/MAT.0000000000002139Test
https://oskar-bordeaux.fr/handle/20.500.12278/188686Test
https://hdl.handle.net/20.500.12278/188686Test

المؤلفون: Monzo, Luca, Levy, Bruno, Duarte, Kevin, Baudry, Guillaume, Combes, Alain, Ouattara, Alexandre, Delmas, Clément, Kimmoun, Antoine, Girerd, Nicolas

المساهمون: Monzo, Luca, Levy, Bruno, Duarte, Kevin, Baudry, Guillaume, Combes, Alain, Ouattara, Alexandre, Delmas, Clément, Kimmoun, Antoine, Girerd, Nicolas

مصطلحات موضوعية: cardiogenic shock, cardiovascular disease, clinical trial, critical care, heart failure

الوصف: Composite outcomes are commonly used in critical care trials to estimate the treatment effect of an intervention. A significant limitation of classical analytic approaches is that they assign equal statistical importance to each component in a composite, even if these do not have the same clinical importance (i.e., in a composite of death and organ failure, death is clearly more important). The win ratio (WR) method has been proposed as an alternative for trial outcomes evaluation, as it effectively assesses events based on their clinical relevance (i.e., hierarchical order) by comparing each patient in the intervention group with their counterparts in the control group. This statistical approach is increasingly used in cardiovascular outcome trials. However, WR may be useful to unveil treatment effects also in the critical care setting, because these trials are typically moderately sized, thus limiting the statistical power to detect small differences between groups, and often rely on composite outcomes that include several components of different clinical importance. Notably, the advantages of this approach may be offset by several drawbacks (such as ignoring ties and difficulties in selecting and ranking endpoints) and challenges in appropriate clinical interpretation (i.e., establishing clinical meaningfulness of the observed effect size). In this perspective article, we present some key elements to implementing WR statistics in critical care trials, providing an overview of strengths, drawbacks, and potential applications of this method. To illustrate, we conduct a reevaluation of the HYPO-ECMO (Hypothermia during Venoarterial Extracorporeal Membrane Oxygenation) trial using the WR framework as a case example.

العلاقة: info:eu-repo/semantics/altIdentifier/pmid/38285595; volume:209; issue:7; firstpage:798; lastpage:804; numberofpages:7; journal:AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE; https://hdl.handle.net/11573/1708885Test; info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-85189750746

الإتاحة: https://doi.org/10.1164/rccm.202309-1644CPTest
https://hdl.handle.net/11573/1708885Test

المؤلفون: de Jong, Audrey, Bignon, Anne, Stephan, François, Godet, Thomas, Constantin, Jean-Michel, Asehnoune, Karim, Sylvestre, Aude, Sautillet, Juliette, Blondonnet, Raiko, Ferrandière, Martine, Seguin, Philippe, Lasocki, Sigismond, Rollé, Amélie, Fayolle, Pierre-Marie, Muller, Laurent, Pardo, Emmanuel, Terzi, Nicolas, Ramin, Séverin, Jung, Boris, Abback, Paer-Selim, Guerci, Philippe, Sarton, Benjamine, Rozé, Hadrien, Dupuis, Claire, Cousson, Joel, Faucher, Marion, Lemiale, Virginie, Cholley, Bernard, Chanques, Gerald, Belafia, Fouad, Huguet, Helena, Futier, Emmanuel, Azoulay, Elie, Molinari, Nicolas, Jaber, Samir, Calypso, Roman, Bouteau-Durand, Astrid, Carles, Michel, Mehdaoui, Hossen, Souweine, Bertrand, Calvet, Laure, Jabaudon, Matthieu, Rieu, Benjamin, Candille, Clara, Sigaud, Florian, Riu, Beatrice, Papazian, Laurent, Valera, Sabine, Mokart, Djamel, Chow Chine, Laurent, Bisbal, Magali, Pouliquen, Camille, de Guibert, Jean-Manuel, Tourret, Maxime, Mallet, Damien, Leone, Marc, Zieleskiewicz, Laurent, Cossic, Jeanne, Assefi, Mona, Baron, Elodie, Quemeneur, Cyril, Monsel, Antoine, Biais, Matthieu, Ouattara, Alexandre, Bonnardel, Eline, Monziols, Simon, Mahul, Martin, Lefrant, Jean-Yves, Roger, Claire, Barbar, Saber, Lambiotte, Fabien, Saint-Leger, Piehr, Paugam, Catherine, Pottecher, Julien, Ludes, Pierre-Olivier, Darrivere, Lucie, Garnier, Marc, Kipnis, Eric, Lebuffe, Gilles, Garot, Matthias, Falcone, Jeremy, Chousterman, Benjamin, Collet, Magali, Gayat, Etienne, Dellamonica, Jean, Mfam, Willy-Serge, Ochin, Evelina, Nebli, Mohamed, Tilouche, Nejla, Madeux, Benjamin, Bougon, David, Aarab, Yassir, Garnier, Fanny

المساهمون: Physiologie & médecine expérimentale du Cœur et des Muscles U 1046 (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Centre Hospitalier Régional Universitaire Montpellier (CHRU Montpellier), Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille), Hypertension pulmonaire : physiopathologie et innovation thérapeutique (HPPIT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université (AMU), Nutrition, Métabolismes et Cancer (NuMeCan), 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), Centre Hospitalier Universitaire de Rennes CHU Rennes = Rennes University Hospital Ponchaillou, 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 universitaire Robert Debré Reims (CHU Reims), Centre Hospitalier Régional Universitaire de Montpellier, PHRCN-18–0078 Finess 340780477, Ministère des Affaires Sociales et de la Santé

المصدر: ISSN: 2213-2600.

مصطلحات موضوعية: [SDV]Life Sciences [q-bio]

الوصف: International audience

العلاقة: info:eu-repo/semantics/altIdentifier/pmid/36693403; hal-03955429; https://hal.science/hal-03955429Test; https://hal.science/hal-03955429/documentTest; https://hal.science/hal-03955429/file/2023%20De%20jong%20et%20al.,%20Effect%20of%20non.pdfTest; PUBMED: 36693403

الإتاحة: https://doi.org/10.1016/S2213-2600Test(22)00529-X
https://hal.science/hal-03955429Test
https://hal.science/hal-03955429/documentTest
https://hal.science/hal-03955429/file/2023%20De%20jong%20et%20al.,%20Effect%20of%20non.pdfTest

المؤلفون: Futier, Emmanuel, Garot, Matthias, Godet, Thomas, Biais, Matthieu, Verzilli, Daniel, Ouattara, Alexandre, Huet, Olivier, Lescot, Thomas, Lebuffe, Gilles, Dewitte, A., Cadic, A., Restoux, A., Asehnoune, K., Paugam-Burtz, C., Cuvillon, P., Faucher, M., Vaisse, C., El Amine, Y., Beloeil, H., Leone, M., Noll, E., Piriou, V., Lasocki, S., Bazin, J. E., Pereira, B., Jaber, S.

المساهمون: Université de Lille, CHU Lille, Service d'Anésthésie Réanimation CHU Clermont-Ferrand, Hôpital Claude Huriez Lille, Service Anesthésie - Réanimation Bordeaux, Département d'anesthésie-réanimation Montpellier, CHRU Brest - Département d'Anesthésie Réanimation CHU - BREST - DAR, Fresenius Kabi, Paris, France, Groupe de Recherche sur les formes Injectables et les Technologies Associées - ULR 7365 GRITA

الوصف: Importance It is not known if use of colloid solutions containing hydroxyethyl starch (HES) to correct for intravascular deficits in high-risk surgical patients is either effective or safe. Objective To evaluate the effect of HES 130/0.4 compared with 0.9% saline for intravascular volume expansion on mortality and postoperative complications after major abdominal surgery. Design, Setting, and Participants Multicenter, double-blind, parallel-group, randomized clinical trial of 775 adult patients at increased risk of postoperative kidney injury undergoing major abdominal surgery at 20 university hospitals in France from February 2016 to July 2018; final follow-up was in October 2018. Interventions Patients were randomized to receive fluid containing either 6% HES 130/0.4 diluted in 0.9% saline (n = 389) or 0.9% saline alone (n = 386) in 250-mL boluses using an individualized hemodynamic algorithm during surgery and for up to 24 hours on the first postoperative day, defined as ending at 7:59 am the following day. Main Outcomes and Measures The primary outcome was a composite of death or major postoperative complications at 14 days after surgery. Secondary outcomes included predefined postoperative complications within 14 days after surgery, durations of intensive care unit and hospital stays, and all-cause mortality at postoperative days 28 and 90. Results Among 826 patients enrolled (mean age, 68 [SD, 7] years; 91 women [12%]), 775 (94%) completed the trial. The primary outcome occurred in 139 of 389 patients (36%) in the HES group and 125 of 386 patients (32%) in the saline group (difference, 3.3% [95% CI, −3.3% to 10.0%]; relative risk, 1.10 [95% CI, 0.91-1.34]; P = .33). Among 12 prespecified secondary outcomes reported, 11 showed no significant difference, but a statistically significant difference was found in median volume of study fluid administered on day 1: 1250 mL (interquartile range, 750-2000 mL) in the HES group and 1500 mL (interquartile range, 750-2150 mL) in the saline group (median difference, 250 ...

وصف الملف: application/octet-stream

العلاقة: JAMA; http://hdl.handle.net/20.500.12210/82548Test

الإتاحة: https://doi.org/20.500.12210/82548Test
https://hdl.handle.net/20.500.12210/82548Test

المؤلفون: CHOLLEY, Bernard, BOJAN, Mirela, GUILLON, Benoit, BESNIER, Emmanuel, MATTEI, Mathieu, LEVY, Bruno, OUATTARA, Alexandre, TAFER, Nadir, DELMAS, Clément, TONON, David, ROZEC, Bertrand, FELLAHI, Jean-Luc, LIM, Pascal, LABASTE, François, ROUBILLE, François, CARUBA, Thibaut, MAURIAT, Philippe

مصطلحات موضوعية: Article clinique, Sciences du Vivant [q-bio]/Médecine humaine et pathologie

الوصف: Correction: Annals of Intensive Care (2023) 13:69 https://doi.org/10.1186/s13613-023-01164-3Test

العلاقة: https://oskar-bordeaux.fr/handle/20.500.12278/184594Test

الإتاحة: https://doi.org/20.500.12278/184594Test
https://doi.org/10.1186/s13613-023-01193-yTest
https://oskar-bordeaux.fr/handle/20.500.12278/184594Test
https://hdl.handle.net/20.500.12278/184594Test

المؤلفون: CHOLLEY, Bernard, BOJAN, Mirela, GUILLON, Benoit, BESNIER, Emmanuel, MATTEI, Mathieu, LEVY, Bruno, OUATTARA, Alexandre, TAFER, Nadir, DELMAS, Clément, TONON, David, ROZEC, Bertrand, FELLAHI, Jean-Luc, LIM, Pascal, LABASTE, François, ROUBILLE, François, CARUBA, Thibaut, MAURIAT, Philippe, BARBOT, Olivier, LAURENT, Berthomieu, BESSELAT, Anne-Marie, KATRIEN, Blanchart, BOUGLE, Adrien, BOURGOIN, Pierre, ARNAUD, Causeret, CHARBONNEAU, Hélène, CRISTINAR, Mircea, DESEBBE, Olivier, ELJEZI, Veldat, GENET, Thibaud, GRENIER, Maxime, GUINOT, Pierre Grégoire, LEBEL, Stéphane, LEVY, Yael, LION, François, MANSOURATI, Jacques, MARLIÈRE, Stéphanie, MARTIN, Anne-Céline, MEBAZAA, Alexandre, MOHAMMAD, Usman, MONSEGU, Jacques, NESSLER, Nicolas, ORSEL, Isabelle, PUYMIRAT, Etienne, RECHER, Morgan, SOUSSI, Sabri, TROUSSARD, Vincent, UHRY, Sabrina, ZIRPHILE, Xavier

مصطلحات موضوعية: Article clinique, Sciences du Vivant [q-bio]/Médecine humaine et pathologie

الوصف: Background Following the results of randomized controlled trials on levosimendan, French health authorities requested an update of the current use and side-effects of this medication on a national scale. Method The France-LEVO registry was a prospective observational cohort study reflecting the indications, dosing regimens, and side-effects of levosimendan, as well as patient outcomes over a year. Results The patients included ( n = 602) represented 29.6% of the national yearly use of levosimendan in France. They were treated for cardiogenic shock ( n = 250, 41.5%), decompensated heart failure ( n = 127, 21.1%), cardiac surgery-related low cardiac output prophylaxis and/or treatment ( n = 86, 14.3%), and weaning from veno-arterial extracorporeal membrane oxygenation ( n = 82, 13.6%). They received 0.18 ± 0.07 µg/kg/min levosimendan over 26 ± 8 h. An initial bolus was administered in 45 patients (7.5%), 103 (17.1%) received repeated infusions, and 461 (76.6%) received inotropes and or vasoactive agents concomitantly. Hypotension was reported in 218 patients (36.2%), atrial fibrillation in 85 (14.1%), and serious adverse events in 17 (2.8%). 136 patients (22.6%) died in hospital, and 26 (4.3%) during the 90-day follow-up. Conclusions We observed that levosimendan was used in accordance with recent recommendations by French physicians. Hypotension and atrial fibrillation remained the most frequent side-effects, while serious adverse event potentially attributable to levosimendan were infrequent. The results suggest that this medication was safe and potentially associated with some benefit in the population studied.

العلاقة: https://oskar-bordeaux.fr/handle/20.500.12278/184368Test

الإتاحة: https://doi.org/20.500.12278/184368Test
https://doi.org/10.1186/s13613-023-01164-3Test
https://oskar-bordeaux.fr/handle/20.500.12278/184368Test
https://hdl.handle.net/20.500.12278/184368Test

المؤلفون: MANSOUR, Alexandre, BEURTON, Antoine, GODIER, Anne, ROZEC, Bertrand, ZLOTNIK, Diane, NEDELEC, Fabienne, GAUSSEM, Pascale, FIORE, Mathieu, BOISSIER, Elodie, NESSELER, Nicolas, OUATTARA, Alexandre

مصطلحات موضوعية: Article clinique, Adult, Humans, Blood Transfusion, Autologous, Blood Platelets, Erythrocytes, Cardiac Surgical Procedures, Hemoglobins, Heparin, Sciences du Vivant [q-bio]/Médecine humaine et pathologie

الوصف: Centrifugation-based autotransfusion devices only salvage red blood cells while platelets are removed. The same™ device (Smart Autotransfusion for ME; i-SEP, France) is an innovative filtration-based autotransfusion device able to salvage both red blood cells and platelets. The authors tested the hypothesis that this new device could allow a red blood cell recovery exceeding 80% with a posttreatment hematocrit exceeding 40%, and would remove more than 90% of heparin and 75% of free hemoglobin. Adults undergoing on-pump elective cardiac surgery were included in a noncomparative multicenter trial. The device was used intraoperatively to treat shed and residual cardiopulmonary bypass blood. The primary outcome was a composite of cell recovery performance, assessed in the device by red blood cell recovery and posttreatment hematocrit, and of biologic safety assessed in the device by the washout of heparin and free hemoglobin expressed as removal ratios. Secondary outcomes included platelet recovery and function and adverse events (clinical and device-related adverse events) up to 30 days after surgery. The study included 50 patients, of whom 18 (35%) underwent isolated coronary artery bypass graft, 26 (52%) valve surgery, and 6 (12%) aortic root surgery. The median red blood cell recovery per cycle was 86.1% (25th percentile to 75th percentile interquartile range, 80.8 to 91.6) with posttreatment hematocrit of 41.8% (39.7 to 44.2). Removal ratios for heparin and free hemoglobin were 98.9% (98.2 to 99.7) and 94.6% (92.7 to 96.6), respectively. No adverse device effect was reported. Median platelet recovery was 52.4% (44.2 to 60.1), with a posttreatment concentration of 116 (93 to 146) · 109/l. Platelet activation state and function, evaluated by flow cytometry, were found to be unaltered by the device. In this first-in-human study, the same™ device was able to simultaneously recover and wash both platelets and red blood cells. Compared with preclinical evaluations, the device achieved a higher platelet recovery of ...

العلاقة: https://oskar-bordeaux.fr/handle/20.500.12278/184366Test

الإتاحة: https://doi.org/20.500.12278/184366Test
https://doi.org/10.1097/ALN.0000000000004642Test
https://oskar-bordeaux.fr/handle/20.500.12278/184366Test
https://hdl.handle.net/20.500.12278/184366Test

المؤلفون: HERION, Francois-Xavier, BEURTON, Antoine, ODDOS, Claire, NUBRET, Karine, AGUERRECHE, Clément, QUESSARD, Astrid, FAURE, Maxime, GERBAUD, Edouard, PERNOT, Mathieu, IMBAULT, Julien, OUATTARA, Alexandre

مصطلحات موضوعية: Article clinique, Life Support, Hospital Rapid Response Team, Multidisciplinary Care Team, Myocardial Infarction, Ventricular Assist Device, Sciences du Vivant [q-bio]/Médecine humaine et pathologie

الوصف: Short-term mechanical circulatory support (STMCS) may be used as an intentional escalation strategy to treat cardiogenic shock refractory (rCS). However, with growing technical possibilities, making the right choice at the right time can be challenging. We established a shock team in January 2013 comprising a cardiac anaesthetist-intensivist, an interventional cardiologist, and a cardiac surgeon. Since then, a diagnosis of rCS has triggered a multidisciplinary team meeting based on a common algorithm. This study aimed to compare the decision-making process for STMCS for rCS before (2007-2013) and after (2013-2019) the creation of the shock team. This before-and-after cohort study was conducted over a 156-month period. Post-cardiotomy rCS were excluded. The primary outcome was a 1-year survival rate. In total, 250 consecutive adult patients were included in the analysis (84 in the control group and 166 in the shock team group). At baseline, the CardShock score was not different between the two groups (5[3-5] vs. 5[4-6], p=0.323). The 1-year survival rate was significantly higher in the shock team group compared to the control group (59% vs. 45%, p = 0.043). After a Cox regression analysis, the shock team intervention was independently associated with a significantly improved 1-year survival rate (HR: 0.592, 95% CI: 0.398-0.880, p=0.010). A multidisciplinary shock team-based decision for STMCS device implantation in rCS is associated with better 1-year survival rates.

العلاقة: https://oskar-bordeaux.fr/handle/20.500.12278/184361Test

الإتاحة: https://doi.org/20.500.12278/184361Test
https://doi.org/10.1093/ehjacc/zuad108Test
https://oskar-bordeaux.fr/handle/20.500.12278/184361Test
https://hdl.handle.net/20.500.12278/184361Test

المؤلفون: DESCAMPS, Richard, AMOUR, Julien, BESNIER, Emmanuel, BOUGLE, Adrien, CHARBONNEAU, Hélène, CHARVIN, Martin, CHOLLEY, Bernard, DESEBBE, Olivier, FELLAHI, Jean-Luc, FRASCA, Denis, LABASTE, François, LENA, Diane, MAHJOUB, Yazine, MERTES, Paul-Michel, MOLLIEX, Serge, MOURI, Pierre-Henry, MOUSSA, Mouhamed Djahoum, OILLEAU, Jean-Ferreol, OUATTARA, Alexandre, PROVENCHERE, Sophie, ROZEC, Bertand, PARIENTI, Jean-Jacques, FISCHER, Marc-Olivier

مصطلحات موضوعية: Arterial pressure, Cardiac surgery, Hemodynamic optimization, Sciences du Vivant [q-bio]/Médecine humaine et pathologie

الوصف: Background: Postoperative morbidity and mortality after cardiac surgery with cardiopulmonary bypass (CPB) remain high despite recent advances in both anesthesia and perioperative management. Among modifiable risk factors for postoperative complications, optimal arterial pressure during and after surgery has been under debate for years. Recent data suggest that optimizing arterial pressure to the baseline of the patient may improve outcomes. We hypothesize that optimizing the mean arterial pressure (MAP) to the baseline MAP of the patient during cardiac surgery with CPB and during the first 24 hours postoperatively may improve outcomes.Study design: The OPTIPAM trial (NCT05403697) will be a multicenter, randomized, open-label controlled trial testing the superiority of optimized MAP management as compared with a MAP of 65mmHg or more during both the intraoperative and postoperative periods in 1100 patients scheduled for cardiac surgery with CPB. The primary composite end point is the occurrence of acute kidney injury, neurological complications including stroke or postoperative delirium, and death. The secondary endpoints are hospital and intensive care unit lengths of stay, Day 7 and Day 90 mortality, postoperative cognitive dysfunction on Day 7 and Day 90, and quality of life at Day 7 and Day 90. An interim analysis will assess the safety of the intervention.Conclusion: The OPTIPAM trial will assess the effectiveness of an individualized target of mean arterial pressure in cardiac surgery with CPB in reducing postoperative morbidity.

العلاقة: https://oskar-bordeaux.fr/handle/20.500.12278/172663Test

الإتاحة: https://doi.org/20.500.12278/172663Test
https://doi.org/10.1016/j.ahj.2023.03.005Test
https://oskar-bordeaux.fr/handle/20.500.12278/172663Test
https://hdl.handle.net/20.500.12278/172663Test