Background The consequences of cardiac arrest (CA) on the gastro-intestinal tract are poorly unde... more Background The consequences of cardiac arrest (CA) on the gastro-intestinal tract are poorly understood. We measured the incidence of ischemic injury in the upper gastro-intestinal tract after Out-of-hospital CA (OHCA) and determined the risk factors for and consequences of gastrointestinal ischemic injury according to its severity. Methods Prospective, non-controlled, multicenter study in nine ICUs in France and Belgium conducted from November 1, 2014 to November 30, 2018. Included patients underwent an esophago-gastro-duodenoscopy 2 to 4 d after OHCA if still intubated and the presence of ischemic lesions of the upper gastro-intestinal tract was determined by a gastroenterologist. Lesions were a priori defined as severe if there was ulceration or necrosis and moderate if there was mucosal edema or erythema. We compared clinical and cardiac arrest characteristics of three groups of patients (no, moderate, and severe lesions) and identified variables associated with gastrointestinal...
Different modes of death are described in selected populations, but few data report the character... more Different modes of death are described in selected populations, but few data report the characteristics of death in a general intensive care unit population. This study analyzed the causes and characteristics of death of critically ill patients and compared anticipated death patients to unexpected death counterparts. An observational multicenter cohort study was performed in 96 intensive care units. During 1 yr, each intensive care unit was randomized to participate during a 1-month period. Demographic data, characteristics of organ failures (Sequential Organ Failure Assessment subscore greater than or equal to 3), and organ supports were collected on all patients who died in the intensive care unit. Modes of death were defined as anticipated (after withdrawal or withholding of treatment or brain death) or unexpected (despite engagement of full-level care or sudden refractory cardiac arrest). A total of 698 patients were included during the study period. At the time of death, 84% ha...
Les fibrates de 2 e generation sont utilises pour leurs proprietes hypolipemiantes, diminuant les... more Les fibrates de 2 e generation sont utilises pour leurs proprietes hypolipemiantes, diminuant les taux plasmatiques du cholesterol et des triglycerides. Leur hepatotoxicite reste exceptionnelle. Nous rapportons un cas d'hepatite aigue cytolytique et cholestatique imputable a un traitement par fenofibrate (secalip®).
Introduction We evaluated the efficacy of and tolerance to mild therapeutic hypothermia achieved ... more Introduction We evaluated the efficacy of and tolerance to mild therapeutic hypothermia achieved using an endovascular cooling system, and its ability to reach and maintain a target temperature of 33°C after cardiac arrest. Methods This study was conducted in the medical-surgical intensive care unit of an urban university hospital. Forty patients admitted to the intensive care unit following out-of-hospital cardiac arrest underwent mild induced hypothermia (MIH). Core temperature was monitored continuously for five days using a Foley catheter equipped with a temperature sensor. Any equipment malfunction was noted and all adverse events attributable to MIH were recorded. Neurological status was evaluated daily using the Pittsburgh Cerebral Performance Category (CPC). We also recorded the mechanism of cardiac arrest, the Simplified Acute Physiologic Score II on admission, standard biological variables, and the estimated time of anoxia. Nosocomial infections during and after MIH until ...
En cas d’infertilite uterine, les patientes desireuses d’un enfant ont comme seule solution l’ado... more En cas d’infertilite uterine, les patientes desireuses d’un enfant ont comme seule solution l’adoption, la gestation pour autrui etant interdite a ce jour en France. Depuis le debut des annees 2000, la recherche sur la transplantation uterine, alternative potentielle a l’adoption, a progresse. Les donnees de l’experimentation animale, les progres de l’immunosuppression et l’experience des grossesses de patientes greffees font qu’une procedure d’allo-transplantation uterine chez la femme devient une eventualite de plus en plus envisageable.
Int. Journal of Clinical Pharmacology and Therapeutics, 2013
Metformin associated lactic acidosis (MALA) is a serious complication occurring especially in eld... more Metformin associated lactic acidosis (MALA) is a serious complication occurring especially in elderly patients given high doses of the drug. We report a non-fatal case of MALA with pronounced acidosis (pH 6.76, lactate 30.81 mmol/l) and high metformin concentrations (127 mg/l) in a patient who had developed acute renal failure after undergoing an operation. Multiple measurements of biological parameters and metformin blood concentrations showed the effectiveness of repeated hemodialysis sessions on metformin elimination. Cases previously reported with such a severe MALA were associated with a high mortality rate. We show that close monitoring in an intensive care unit together with prompt and repeated dialysis sessions can lead to a favorable outcome.
Abstract Background and Aim The molecular adsorbent recirculating system (MARS) is the most widel... more Abstract Background and Aim The molecular adsorbent recirculating system (MARS) is the most widely used device to treat liver failure. Nevertheless, data from widespread real‐life use are lacking. Methods This was a retrospective multicenter study conducted in all French adult care centers that used MARS between 2004 and 2009. The primary objective was to evaluate patient survival according to the liver disease and listing status. Factors associated with mortality were the secondary objectives. Results A total of 383 patients underwent 393 MARS treatments. The main indications were acute liver failure (ALF, 32.6%), and severe cholestasis (total bilirubin >340 μmol/L) (37.2%), hepatic encephalopathy (23.7%), and/or acute kidney injury–hepatorenal syndrome (22.9%) most often among patients with chronic liver disease. At the time of treatment, 34.4% of the patients were listed. Overall, the hospital survival rate was 49% (95% CI: 44–54%) and ranged from 25% to 81% depending on the diagnosis of the liver disease. In listed patients versus those not listed, the 1‐year survival rate was markedly better in the setting of nonbiliary cirrhosis (59% vs 15%), early graft nonfunction (80% vs 0%), and late graft dysfunction (72% vs 0%) (all P < 0.001). Among nonbiliary cirrhotic patients, hospital mortality was associated with the severity of liver disease (HE and severe cholestasis) and not being listed for transplant. In ALF, paracetamol etiology and ≥3 MARS sessions were associated with better transplant‐free survival. Conclusion Our study suggests that MARS should be mainly used as a bridge to liver transplantation. Survival was correlated with being listed for most etiologies and with the intensity of treatment in ALF.
IntroductionStatus epilepticus (SE) is a common life-threatening neurological emergency that can ... more IntroductionStatus epilepticus (SE) is a common life-threatening neurological emergency that can cause long-term impairments. Overall outcomes remain poor. Major efforts are required to clarify the epidemiology of SE and the determinants of outcomes, thereby identifying targets for improved management.Methods and analysisICTAL Registry is a multicentre open cohort of critically ill patients with convulsive, non-convulsive or psychogenic non-epileptic SE. Observational methods are applied to collect uniform data. The goal of the ICTAL Registry is to collect high-quality information on a large number of patients, thereby allowing elucidation of the pathophysiological mechanisms involved in mortality and morbidity. The registry structure is modular, with a large core data set and the opportunity for research teams to create satellite data sets for observational or interventional studies (eg, cohort multiple randomised controlled trials, cross-sectional studies and short-term and long-t...
Interest of low-dose hydrocortisone therapy during brain-dead organ donor resuscitation: the CORT... more Interest of low-dose hydrocortisone therapy during brain-dead organ donor resuscitation: the CORTICOME study.
Les abces non parasitaires du foie sont peu frequents et dans la plupart des cas secondaires a un... more Les abces non parasitaires du foie sont peu frequents et dans la plupart des cas secondaires a une infection biliaire ascendante. Plus rarement, ils peuvent etre d'origine hematogene lors d'une septicemie. Nous rapportons un cas d'abces hepatiques compliquant une septicemie a Clostridium perfringens.
Introduction: Early prognostication is a major challenge in comatose survivors of OHCA. Hypothesi... more Introduction: Early prognostication is a major challenge in comatose survivors of OHCA. Hypothesis: We hypothesized that a wide analysis of the transcriptome could offer new prognostic tools and research axes. Methods: Patients were enrolled from an ancillary study of the clinical trial NCT00999583 that tested the effect of a high dose of erythropoietin (EPO) after OHCA. Blood samples were collected in comatose survivors of cardiac arrest at hospital admission and at days 1 and 3. Whole-blood RNA was purified, and processed to be hybridized on an Illumina HumanHT-12 V4 gene expression BeadChip, allowing a follow up of more than 34000 genes. Transcriptome profiles were compared between patients with favorable vs poor outcome (Cerebral performance category [CPC] 1-2 vs CPC>2) and treated or not by EPO (fold change >1.3; p<0.05). Results: Blood collection was performed in 69 patients. Among them, 33 and 36 patients were treated by EPO or not, respectively. The outcome was not ...
La survenue d'un pneumoperitoine et d'un retro-pneumoperitoine chez un malade venant d... more La survenue d'un pneumoperitoine et d'un retro-pneumoperitoine chez un malade venant d'avoir une coloscopie evoque d'emblee une perforation iatrogene du tube digestif [1, 2]. La prise en charge therapeutiquede ces perforations coliques reste discutee [1, 3]. Les auteurs rapportent le traitement non chirurgical d'une perforation colique survenue apres une coloscopie realisee lors d'une premiere poussee severe de maladie de Crohn.
Ascitic fluid infection (AFI) is a life-threatening complication of cirrhosis. We aimed to identi... more Ascitic fluid infection (AFI) is a life-threatening complication of cirrhosis. We aimed to identify early indicators of secondary peritonitis (SP), which requires emergency surgery, and to describe the outcomes of SP and spontaneous bacterial/fungal peritonitis (SBFP). Adults with cirrhosis and AFI admitted to 16 university or university-affiliated ICUs in France between 2002 and 2017 were studied retrospectively. Cases were identified by searching the hospital databases for relevant ICD-10 codes and hospital charts for AFI. Logistic multivariate regression was performed to identify factors associated with SP. Secondary outcomes were short- and long-term mortality and survivors’ functional outcomes. Of 178 included patients (137 men and 41 women; mean age, 58 ± 11 years), 21 (11.8%) had SP, confirmed by surgery in 16 cases and by abdominal computed tomography in 5 cases. Time to diagnosis exceeded 24 h in 7/21 patients with SP. By multivariate analysis, factors independently associa...
Background The consequences of cardiac arrest (CA) on the gastro-intestinal tract are poorly unde... more Background The consequences of cardiac arrest (CA) on the gastro-intestinal tract are poorly understood. We measured the incidence of ischemic injury in the upper gastro-intestinal tract after Out-of-hospital CA (OHCA) and determined the risk factors for and consequences of gastrointestinal ischemic injury according to its severity. Methods Prospective, non-controlled, multicenter study in nine ICUs in France and Belgium conducted from November 1, 2014 to November 30, 2018. Included patients underwent an esophago-gastro-duodenoscopy 2 to 4 d after OHCA if still intubated and the presence of ischemic lesions of the upper gastro-intestinal tract was determined by a gastroenterologist. Lesions were a priori defined as severe if there was ulceration or necrosis and moderate if there was mucosal edema or erythema. We compared clinical and cardiac arrest characteristics of three groups of patients (no, moderate, and severe lesions) and identified variables associated with gastrointestinal...
Different modes of death are described in selected populations, but few data report the character... more Different modes of death are described in selected populations, but few data report the characteristics of death in a general intensive care unit population. This study analyzed the causes and characteristics of death of critically ill patients and compared anticipated death patients to unexpected death counterparts. An observational multicenter cohort study was performed in 96 intensive care units. During 1 yr, each intensive care unit was randomized to participate during a 1-month period. Demographic data, characteristics of organ failures (Sequential Organ Failure Assessment subscore greater than or equal to 3), and organ supports were collected on all patients who died in the intensive care unit. Modes of death were defined as anticipated (after withdrawal or withholding of treatment or brain death) or unexpected (despite engagement of full-level care or sudden refractory cardiac arrest). A total of 698 patients were included during the study period. At the time of death, 84% ha...
Les fibrates de 2 e generation sont utilises pour leurs proprietes hypolipemiantes, diminuant les... more Les fibrates de 2 e generation sont utilises pour leurs proprietes hypolipemiantes, diminuant les taux plasmatiques du cholesterol et des triglycerides. Leur hepatotoxicite reste exceptionnelle. Nous rapportons un cas d'hepatite aigue cytolytique et cholestatique imputable a un traitement par fenofibrate (secalip®).
Introduction We evaluated the efficacy of and tolerance to mild therapeutic hypothermia achieved ... more Introduction We evaluated the efficacy of and tolerance to mild therapeutic hypothermia achieved using an endovascular cooling system, and its ability to reach and maintain a target temperature of 33°C after cardiac arrest. Methods This study was conducted in the medical-surgical intensive care unit of an urban university hospital. Forty patients admitted to the intensive care unit following out-of-hospital cardiac arrest underwent mild induced hypothermia (MIH). Core temperature was monitored continuously for five days using a Foley catheter equipped with a temperature sensor. Any equipment malfunction was noted and all adverse events attributable to MIH were recorded. Neurological status was evaluated daily using the Pittsburgh Cerebral Performance Category (CPC). We also recorded the mechanism of cardiac arrest, the Simplified Acute Physiologic Score II on admission, standard biological variables, and the estimated time of anoxia. Nosocomial infections during and after MIH until ...
En cas d’infertilite uterine, les patientes desireuses d’un enfant ont comme seule solution l’ado... more En cas d’infertilite uterine, les patientes desireuses d’un enfant ont comme seule solution l’adoption, la gestation pour autrui etant interdite a ce jour en France. Depuis le debut des annees 2000, la recherche sur la transplantation uterine, alternative potentielle a l’adoption, a progresse. Les donnees de l’experimentation animale, les progres de l’immunosuppression et l’experience des grossesses de patientes greffees font qu’une procedure d’allo-transplantation uterine chez la femme devient une eventualite de plus en plus envisageable.
Int. Journal of Clinical Pharmacology and Therapeutics, 2013
Metformin associated lactic acidosis (MALA) is a serious complication occurring especially in eld... more Metformin associated lactic acidosis (MALA) is a serious complication occurring especially in elderly patients given high doses of the drug. We report a non-fatal case of MALA with pronounced acidosis (pH 6.76, lactate 30.81 mmol/l) and high metformin concentrations (127 mg/l) in a patient who had developed acute renal failure after undergoing an operation. Multiple measurements of biological parameters and metformin blood concentrations showed the effectiveness of repeated hemodialysis sessions on metformin elimination. Cases previously reported with such a severe MALA were associated with a high mortality rate. We show that close monitoring in an intensive care unit together with prompt and repeated dialysis sessions can lead to a favorable outcome.
Abstract Background and Aim The molecular adsorbent recirculating system (MARS) is the most widel... more Abstract Background and Aim The molecular adsorbent recirculating system (MARS) is the most widely used device to treat liver failure. Nevertheless, data from widespread real‐life use are lacking. Methods This was a retrospective multicenter study conducted in all French adult care centers that used MARS between 2004 and 2009. The primary objective was to evaluate patient survival according to the liver disease and listing status. Factors associated with mortality were the secondary objectives. Results A total of 383 patients underwent 393 MARS treatments. The main indications were acute liver failure (ALF, 32.6%), and severe cholestasis (total bilirubin >340 μmol/L) (37.2%), hepatic encephalopathy (23.7%), and/or acute kidney injury–hepatorenal syndrome (22.9%) most often among patients with chronic liver disease. At the time of treatment, 34.4% of the patients were listed. Overall, the hospital survival rate was 49% (95% CI: 44–54%) and ranged from 25% to 81% depending on the diagnosis of the liver disease. In listed patients versus those not listed, the 1‐year survival rate was markedly better in the setting of nonbiliary cirrhosis (59% vs 15%), early graft nonfunction (80% vs 0%), and late graft dysfunction (72% vs 0%) (all P < 0.001). Among nonbiliary cirrhotic patients, hospital mortality was associated with the severity of liver disease (HE and severe cholestasis) and not being listed for transplant. In ALF, paracetamol etiology and ≥3 MARS sessions were associated with better transplant‐free survival. Conclusion Our study suggests that MARS should be mainly used as a bridge to liver transplantation. Survival was correlated with being listed for most etiologies and with the intensity of treatment in ALF.
IntroductionStatus epilepticus (SE) is a common life-threatening neurological emergency that can ... more IntroductionStatus epilepticus (SE) is a common life-threatening neurological emergency that can cause long-term impairments. Overall outcomes remain poor. Major efforts are required to clarify the epidemiology of SE and the determinants of outcomes, thereby identifying targets for improved management.Methods and analysisICTAL Registry is a multicentre open cohort of critically ill patients with convulsive, non-convulsive or psychogenic non-epileptic SE. Observational methods are applied to collect uniform data. The goal of the ICTAL Registry is to collect high-quality information on a large number of patients, thereby allowing elucidation of the pathophysiological mechanisms involved in mortality and morbidity. The registry structure is modular, with a large core data set and the opportunity for research teams to create satellite data sets for observational or interventional studies (eg, cohort multiple randomised controlled trials, cross-sectional studies and short-term and long-t...
Interest of low-dose hydrocortisone therapy during brain-dead organ donor resuscitation: the CORT... more Interest of low-dose hydrocortisone therapy during brain-dead organ donor resuscitation: the CORTICOME study.
Les abces non parasitaires du foie sont peu frequents et dans la plupart des cas secondaires a un... more Les abces non parasitaires du foie sont peu frequents et dans la plupart des cas secondaires a une infection biliaire ascendante. Plus rarement, ils peuvent etre d'origine hematogene lors d'une septicemie. Nous rapportons un cas d'abces hepatiques compliquant une septicemie a Clostridium perfringens.
Introduction: Early prognostication is a major challenge in comatose survivors of OHCA. Hypothesi... more Introduction: Early prognostication is a major challenge in comatose survivors of OHCA. Hypothesis: We hypothesized that a wide analysis of the transcriptome could offer new prognostic tools and research axes. Methods: Patients were enrolled from an ancillary study of the clinical trial NCT00999583 that tested the effect of a high dose of erythropoietin (EPO) after OHCA. Blood samples were collected in comatose survivors of cardiac arrest at hospital admission and at days 1 and 3. Whole-blood RNA was purified, and processed to be hybridized on an Illumina HumanHT-12 V4 gene expression BeadChip, allowing a follow up of more than 34000 genes. Transcriptome profiles were compared between patients with favorable vs poor outcome (Cerebral performance category [CPC] 1-2 vs CPC>2) and treated or not by EPO (fold change >1.3; p<0.05). Results: Blood collection was performed in 69 patients. Among them, 33 and 36 patients were treated by EPO or not, respectively. The outcome was not ...
La survenue d'un pneumoperitoine et d'un retro-pneumoperitoine chez un malade venant d... more La survenue d'un pneumoperitoine et d'un retro-pneumoperitoine chez un malade venant d'avoir une coloscopie evoque d'emblee une perforation iatrogene du tube digestif [1, 2]. La prise en charge therapeutiquede ces perforations coliques reste discutee [1, 3]. Les auteurs rapportent le traitement non chirurgical d'une perforation colique survenue apres une coloscopie realisee lors d'une premiere poussee severe de maladie de Crohn.
Ascitic fluid infection (AFI) is a life-threatening complication of cirrhosis. We aimed to identi... more Ascitic fluid infection (AFI) is a life-threatening complication of cirrhosis. We aimed to identify early indicators of secondary peritonitis (SP), which requires emergency surgery, and to describe the outcomes of SP and spontaneous bacterial/fungal peritonitis (SBFP). Adults with cirrhosis and AFI admitted to 16 university or university-affiliated ICUs in France between 2002 and 2017 were studied retrospectively. Cases were identified by searching the hospital databases for relevant ICD-10 codes and hospital charts for AFI. Logistic multivariate regression was performed to identify factors associated with SP. Secondary outcomes were short- and long-term mortality and survivors’ functional outcomes. Of 178 included patients (137 men and 41 women; mean age, 58 ± 11 years), 21 (11.8%) had SP, confirmed by surgery in 16 cases and by abdominal computed tomography in 5 cases. Time to diagnosis exceeded 24 h in 7/21 patients with SP. By multivariate analysis, factors independently associa...
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