Annales Francaises D Anesthesie Et De Reanimation, Sep 1, 2014
Introduction La desescalade de l’antibiotherapie probabiliste est une des strategies recommandees... more Introduction La desescalade de l’antibiotherapie probabiliste est une des strategies recommandees [1] pour eviter l’emergence de pathogenes resistants aux antibiotiques. Toutefois, aucune etude randomisee n’a montre un benefice en termes d’efficacite et de securite pour le patient [2] . Nous avons donc compare une strategie de desescalade de l’antibiotherapie probabiliste versus son maintien chez les patients en sepsis severe en reanimation. Materiel et methodes Parmi les patients, 116 ont ete inclus et randomises en un groupe Desescalade ou un groupe Maintien de l’antibiotherapie probabiliste dans cet essai multicentrique, prospectif, de non-inferiorite avec l’accord du Comite de Protection des Personnes Sud Mediterranee I. Le critere de jugement principal etait la duree d’hospitalisation en reanimation. Les objectifs secondaires etaient la mortalite a 90 jours, la survenue de defaillance d’organe, la survenue d’une nouvelle infection et le nombre de jours sous antibiotiques durant le sejour en reanimation. Un consentement eclaire etait signe par le patient ou par la personne de confiance avant inclusion. Resultats La duree d’hospitalisation en reanimation a partir du jour d’inclusion etait de 15 (± 15) jours pour le groupe Desescalade et de 12 (± 13) jours pour le groupe Maintien (p = 0,71). Il n’y avait pas de difference significative concernant la mortalite, la duree de ventilation mecanique ou de choc, ou le nombre de defaillance d’organe. Seize (27 %) patients ont presente une nouvelle infection apres l’inclusion dans le groupe Desescalade versus 6 (11 %) patients dans le groupe Maintien (p = 0,03). La duree cumulee des differents traitements antibiotiques au cours de l’etude etait de 14 (± 13) jours pour le groupe Desescalade contre 10 (± 7) jours pour le groupe Maintien (p = 0,11). Discussion En termes de duree de sejour en reanimation, la non-inferiorite de la procedure de desescalade de l’antibiotherapie probabiliste n’a pas pu etre demontree dans cette etude. Il est important de tester a nouveau la securite de la procedure de desescalade par d’autres etudes prospectives et randomisees, mais egalement de pouvoir conclure sur l’emergence de bacteries multi-resistantes, ainsi que les couts de prise en charge associes aux deux procedures.
BACKGROUND. Delayed cerebral ischaemia (DCI) following aneurysmal subarachnoid haemorrhage (aSAH)... more BACKGROUND. Delayed cerebral ischaemia (DCI) following aneurysmal subarachnoid haemorrhage (aSAH) is a major cause of complications and death. Here we set out to identify high-performance predictive biomarkers of DCI and its underlying metabolic disruptions using metabolomics and lipidomics approaches. METHODS. This single-centre retrospective observational study enrolled 61 consecutive patients with severe aSAH requiring external ventricular drainage between 2013 and 2016, among them 22 experienced a DCI. Blood and cerebrospinal fluid (CSF) were sampled within the first 24 h after admission. We carried out LC-MS/MS-based plasma and CSF metabolomic and lipidomic profiling together with total fatty acids analysis. RESULTS. We identified a panel of 20 metabolites that together showed high predictive performance for DCI (area under the receiver operating characteristic curve: 0.968). This panel of metabolites included lactate, cotinine, salicylate, 6 phosphatidylcholines, and 4 sphingo...
Anaesthesia, critical care & pain medicine, Jan 12, 2018
In elderly patients, goal-directed haemodynamic therapy (GDHT), depth of anaesthesia monitoring a... more In elderly patients, goal-directed haemodynamic therapy (GDHT), depth of anaesthesia monitoring and lung-protective ventilation have been shown to improve postoperative outcomes. The aim of this study was to evaluate current practices concerning strategies of anaesthesia optimisation in patients aged≥75 years. A multicentre observational study was performed from February to May 2015 in 23 French academic centres. On 30 consecutive days in each centre, patients≥75 years with at least one major comorbidity undergoing elective or emergency procedures (femoral-neck fractures surgery, intraperitoneal abdominal surgery or vascular surgery) were included. Patient characteristics and data related to GHDT, management of hypotension, monitoring of temperature and depth of anaesthesia, lung ventilation, point of care haemoglobin testing were collected. In total, 807 patients were included. Only 2% of patients [95% CI: 1-3] received GHDT in full accordance with guidelines. Depth of anaesthesia ...
Delayed cerebral ischaemia from vasospasm is an important cause of complications and death after ... more Delayed cerebral ischaemia from vasospasm is an important cause of complications and death after aneurysmal subarachnoid haemorrhage. There is currently no established biomarker for identifying patients at high risk of delayed cerebral ischaemia. Considering the important role of inflammation in the pathogenesis of delayed cerebral ischaemia, we investigated whether matrix metalloproteinase-9 (MMP-9) may be an efficient biomarker for predicting elayed cerebral ischaemia after subarachnoid haemorrhage. Single-centre prospective observational study in a Neuroscience Critical Care Unit of a teaching hospital. Thirty consecutive patients with severe subarachnoid haemorrhage requiring external ventricular drainage were enrolled during 2013 and 2014. Blood and cerebrospinal fluid (CSF) were sampled within the first 24 h and between 48 and 72 h after admission. We evaluated the activity and concentrations of MMP-9 and endothelin-1 with zymography and ELISA. Patients were allocated to group...
ImportanceGeneral anesthesia and procedural sedation are common practice for mechanical thrombect... more ImportanceGeneral anesthesia and procedural sedation are common practice for mechanical thrombectomy in acute ischemic stroke. However, risks and benefits of each strategy are unclear.ObjectiveTo determine whether general anesthesia or procedural sedation for anterior circulation large-vessel occlusion acute ischemic stroke thrombectomy are associated with a difference in periprocedural complications and 3-month functional outcome.Design, Setting, and ParticipantsThis open-label, blinded end point randomized clinical trial was conducted between August 2017 and February 2020, with final follow-up in May 2020, at 10 centers in France.Adults with occlusion of the intracranial internal carotid artery and/or the proximal middle cerebral artery treated with thrombectomy were enrolled.InterventionsPatients were assigned to receive general anesthesia with tracheal intubation (n = 135) or procedural sedation (n = 138).Main Outcomes and MeasuresThe prespecified primary composite outcome was f...
Objectives: To describe clinical characteristics and management of intensive care units (ICU) pat... more Objectives: To describe clinical characteristics and management of intensive care units (ICU) patients with laboratory-confirmed COVID-19 and to determine 90-day mortality after ICU admission and associated risk factors. Methods: This observational retrospective study was conducted in six intensive care units (ICUs) in three university hospitals in Marseille, France. Between 10 March and 10 May 2020, all adult patients admitted in ICU with laboratory-confirmed SARS-CoV-2 and respiratory failure were eligible for inclusion. The statistical analysis was focused on the mechanically ventilated patients. The primary outcome was the 90-day mortality after ICU admission. Results: Included in the study were 172 patients with COVID-19 related respiratory failure, 117 of whom (67%) received invasive mechanical ventilation. 90-day mortality of the invasively ventilated patients was 27.4%. Median duration of ventilation and median length of stay in ICU for these patients were 20 (9–33) days and...
Annales Francaises D Anesthesie Et De Reanimation, Sep 1, 2014
Introduction La desescalade de l’antibiotherapie probabiliste est une des strategies recommandees... more Introduction La desescalade de l’antibiotherapie probabiliste est une des strategies recommandees [1] pour eviter l’emergence de pathogenes resistants aux antibiotiques. Toutefois, aucune etude randomisee n’a montre un benefice en termes d’efficacite et de securite pour le patient [2] . Nous avons donc compare une strategie de desescalade de l’antibiotherapie probabiliste versus son maintien chez les patients en sepsis severe en reanimation. Materiel et methodes Parmi les patients, 116 ont ete inclus et randomises en un groupe Desescalade ou un groupe Maintien de l’antibiotherapie probabiliste dans cet essai multicentrique, prospectif, de non-inferiorite avec l’accord du Comite de Protection des Personnes Sud Mediterranee I. Le critere de jugement principal etait la duree d’hospitalisation en reanimation. Les objectifs secondaires etaient la mortalite a 90 jours, la survenue de defaillance d’organe, la survenue d’une nouvelle infection et le nombre de jours sous antibiotiques durant le sejour en reanimation. Un consentement eclaire etait signe par le patient ou par la personne de confiance avant inclusion. Resultats La duree d’hospitalisation en reanimation a partir du jour d’inclusion etait de 15 (± 15) jours pour le groupe Desescalade et de 12 (± 13) jours pour le groupe Maintien (p = 0,71). Il n’y avait pas de difference significative concernant la mortalite, la duree de ventilation mecanique ou de choc, ou le nombre de defaillance d’organe. Seize (27 %) patients ont presente une nouvelle infection apres l’inclusion dans le groupe Desescalade versus 6 (11 %) patients dans le groupe Maintien (p = 0,03). La duree cumulee des differents traitements antibiotiques au cours de l’etude etait de 14 (± 13) jours pour le groupe Desescalade contre 10 (± 7) jours pour le groupe Maintien (p = 0,11). Discussion En termes de duree de sejour en reanimation, la non-inferiorite de la procedure de desescalade de l’antibiotherapie probabiliste n’a pas pu etre demontree dans cette etude. Il est important de tester a nouveau la securite de la procedure de desescalade par d’autres etudes prospectives et randomisees, mais egalement de pouvoir conclure sur l’emergence de bacteries multi-resistantes, ainsi que les couts de prise en charge associes aux deux procedures.
BACKGROUND. Delayed cerebral ischaemia (DCI) following aneurysmal subarachnoid haemorrhage (aSAH)... more BACKGROUND. Delayed cerebral ischaemia (DCI) following aneurysmal subarachnoid haemorrhage (aSAH) is a major cause of complications and death. Here we set out to identify high-performance predictive biomarkers of DCI and its underlying metabolic disruptions using metabolomics and lipidomics approaches. METHODS. This single-centre retrospective observational study enrolled 61 consecutive patients with severe aSAH requiring external ventricular drainage between 2013 and 2016, among them 22 experienced a DCI. Blood and cerebrospinal fluid (CSF) were sampled within the first 24 h after admission. We carried out LC-MS/MS-based plasma and CSF metabolomic and lipidomic profiling together with total fatty acids analysis. RESULTS. We identified a panel of 20 metabolites that together showed high predictive performance for DCI (area under the receiver operating characteristic curve: 0.968). This panel of metabolites included lactate, cotinine, salicylate, 6 phosphatidylcholines, and 4 sphingo...
Anaesthesia, critical care & pain medicine, Jan 12, 2018
In elderly patients, goal-directed haemodynamic therapy (GDHT), depth of anaesthesia monitoring a... more In elderly patients, goal-directed haemodynamic therapy (GDHT), depth of anaesthesia monitoring and lung-protective ventilation have been shown to improve postoperative outcomes. The aim of this study was to evaluate current practices concerning strategies of anaesthesia optimisation in patients aged≥75 years. A multicentre observational study was performed from February to May 2015 in 23 French academic centres. On 30 consecutive days in each centre, patients≥75 years with at least one major comorbidity undergoing elective or emergency procedures (femoral-neck fractures surgery, intraperitoneal abdominal surgery or vascular surgery) were included. Patient characteristics and data related to GHDT, management of hypotension, monitoring of temperature and depth of anaesthesia, lung ventilation, point of care haemoglobin testing were collected. In total, 807 patients were included. Only 2% of patients [95% CI: 1-3] received GHDT in full accordance with guidelines. Depth of anaesthesia ...
Delayed cerebral ischaemia from vasospasm is an important cause of complications and death after ... more Delayed cerebral ischaemia from vasospasm is an important cause of complications and death after aneurysmal subarachnoid haemorrhage. There is currently no established biomarker for identifying patients at high risk of delayed cerebral ischaemia. Considering the important role of inflammation in the pathogenesis of delayed cerebral ischaemia, we investigated whether matrix metalloproteinase-9 (MMP-9) may be an efficient biomarker for predicting elayed cerebral ischaemia after subarachnoid haemorrhage. Single-centre prospective observational study in a Neuroscience Critical Care Unit of a teaching hospital. Thirty consecutive patients with severe subarachnoid haemorrhage requiring external ventricular drainage were enrolled during 2013 and 2014. Blood and cerebrospinal fluid (CSF) were sampled within the first 24 h and between 48 and 72 h after admission. We evaluated the activity and concentrations of MMP-9 and endothelin-1 with zymography and ELISA. Patients were allocated to group...
ImportanceGeneral anesthesia and procedural sedation are common practice for mechanical thrombect... more ImportanceGeneral anesthesia and procedural sedation are common practice for mechanical thrombectomy in acute ischemic stroke. However, risks and benefits of each strategy are unclear.ObjectiveTo determine whether general anesthesia or procedural sedation for anterior circulation large-vessel occlusion acute ischemic stroke thrombectomy are associated with a difference in periprocedural complications and 3-month functional outcome.Design, Setting, and ParticipantsThis open-label, blinded end point randomized clinical trial was conducted between August 2017 and February 2020, with final follow-up in May 2020, at 10 centers in France.Adults with occlusion of the intracranial internal carotid artery and/or the proximal middle cerebral artery treated with thrombectomy were enrolled.InterventionsPatients were assigned to receive general anesthesia with tracheal intubation (n = 135) or procedural sedation (n = 138).Main Outcomes and MeasuresThe prespecified primary composite outcome was f...
Objectives: To describe clinical characteristics and management of intensive care units (ICU) pat... more Objectives: To describe clinical characteristics and management of intensive care units (ICU) patients with laboratory-confirmed COVID-19 and to determine 90-day mortality after ICU admission and associated risk factors. Methods: This observational retrospective study was conducted in six intensive care units (ICUs) in three university hospitals in Marseille, France. Between 10 March and 10 May 2020, all adult patients admitted in ICU with laboratory-confirmed SARS-CoV-2 and respiratory failure were eligible for inclusion. The statistical analysis was focused on the mechanically ventilated patients. The primary outcome was the 90-day mortality after ICU admission. Results: Included in the study were 172 patients with COVID-19 related respiratory failure, 117 of whom (67%) received invasive mechanical ventilation. 90-day mortality of the invasively ventilated patients was 27.4%. Median duration of ventilation and median length of stay in ICU for these patients were 20 (9–33) days and...
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