Publications by authors named "Chloé Cantero"

9 Publications

  • Page 1 of 1

Impact of Confinement in Patients under Long-Term Noninvasive Ventilation during the First Wave of the SARS-CoV-2 Pandemic: A Remarkable Resilience.

Respiration 2021 15;100(9):909-917. Epub 2021 Jun 15.

Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland.

Background: During the first wave of the SARS-CoV-2 pandemic in Switzerland, confinement was imposed to limit transmission and protect vulnerable persons. These measures may have had a negative impact on perceived quality of care and symptoms in patients with chronic disorders.

Objectives: To determine whether patients under long-term home noninvasive ventilation (LTHNIV) for chronic respiratory failure (CRF) were negatively affected by the 56-day confinement (March-April 2020).

Methods: A questionnaire-based survey exploring mood disturbances (HAD), symptom scores related to NIV (S3-NIV), and perception of health-care providers during confinement was sent to all patients under LTHNIV followed up by our center. Symptom scores and data obtained by ventilator software were compared between confinement and the 56 days prior to confinement.

Results: Of a total of 100 eligible patients, 66 were included (median age: 66 years [IQR: 53-74]): 35 (53%) with restrictive lung disorders, 20 (30%) with OHS or SRBD, and 11 (17%) with COPD or overlap syndrome. Prevalence of anxiety (n = 7; 11%) and depressive (n = 2; 3%) disorders was remarkably low. Symptom scores were slightly higher during confinement although this difference was not clinically relevant. Technical data regarding ventilation, including compliance, did not change. Patients complained of isolation and lack of social contact. They felt supported by their relatives and caregivers but complained of the lack of regular contact and information by health-care professionals.

Conclusions: Patients under LTHNIV for CRF showed a remarkable resilience during the SARS-CoV-2 confinement period. Comments provided may be helpful for managing similar future health-care crises.
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http://dx.doi.org/10.1159/000516327DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8339039PMC
September 2021

Self-proning in COVID-19 patients on low-flow oxygen therapy: a cluster randomised controlled trial.

ERJ Open Res 2021 Jan 8;7(1). Epub 2021 Mar 8.

Division of Lung Diseases, Geneva University Hospitals, Geneva, Switzerland.

Rationale And Objectives: Prone positioning as a complement to oxygen therapy to treat hypoxaemia in coronavirus disease 2019 (COVID-19) pneumonia in spontaneously breathing patients has been widely adopted, despite a lack of evidence for its benefit. We tested the hypothesis that a simple incentive to self-prone for a maximum of 12 h per day would decrease oxygen needs in patients admitted to the ward for COVID-19 pneumonia on low-flow oxygen therapy.

Methods: 27 patients with confirmed COVID-19 pneumonia admitted to Geneva University Hospitals were included in the study. 10 patients were randomised to self-prone positioning and 17 to usual care.

Measurements And Main Results: Oxygen needs assessed by oxygen flow on nasal cannula at inclusion were similar between groups. 24 h after starting the intervention, the median (interquartile range (IQR)) oxygen flow was 1.0 (0.1-2.9) L·min in the prone position group and 2.0 (0.5-3.0) L·min in the control group (p=0.507). Median (IQR) oxygen saturation/fraction of inspired oxygen ratio was 390 (300-432) in the prone position group and 336 (294-422) in the control group (p=0.633). One patient from the intervention group who did not self-prone was transferred to the high-dependency unit. Self-prone positioning was easy to implement. The intervention was well tolerated and only mild side-effects were reported.

Conclusions: Self-prone positioning in patients with COVID-19 pneumonia requiring low-flow oxygen therapy resulted in a clinically meaningful reduction of oxygen flow, but without reaching statistical significance.
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http://dx.doi.org/10.1183/23120541.00692-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869594PMC
January 2021

Long-Term Non-invasive Ventilation: Do Patients Aged Over 75 Years Differ From Younger Adults?

Front Med (Lausanne) 2020 11;7:556218. Epub 2020 Nov 11.

Division of Pulmonary Diseases, Geneva University Hospitals (HUG), Geneva, Switzerland.

Noninvasive ventilation (NIV) is accepted as standard of care for chronic hypercapnic respiratory failure (CHRF) and is being increasingly implemented in older subjects. However, little is known regarding the use of NIV on a long-term basis in the very old. The outcomes of this study were: 1/to report the proportion of patients ≥ 75 years old (elderly) among a large group of long-term NIV users and its trend since 2000; 2/to compare this population to a younger population (<75 years old) under long-term NIV in terms of diagnoses, comorbidities, anthropometric data, technical aspects, adherence to and efficiency of NIV. In a cross-sectional analysis of a multicenter cohort study on patients with CHRF under NIV, diagnoses, comorbidities, technical aspects, adherence to and efficiency of NIV were compared between patients ≥ 75 and <75 years old (chi-square or Welch Student tests). Of a total of 489 patients under NIV, 151 patients (31%) were ≥ 75 years of age. Comorbidities such as systemic hypertension (86 vs. 60%, < 0.001), chronic heart failure (30 vs. 18%, = 0.005), and pulmonary hypertension (25 vs. 14%, = 0.005) were more frequent in older subjects. In the older group, there was a trend for a higher prevalence of chronic obstructive pulmonary disease (COPD) (46 vs. 36%, = 0.151) and a lower prevalence of neuromuscular diseases (NMD) (19 vs. 11%, = 0.151), although not significant. Adherence to and efficacy of NIV were similar in both groups (daily use of ventilator: 437 vs. 419 min, = 0.76; PaCO: 5.8 vs. 5.9 kPa, = 0.968). Unintentional leaks were slightly higher in the older group (1.8 vs. 0.6 L/min, = 0.018). In this cross-sectional study, one third of the population under NIV was ≥ 75 years old. Markers of efficacy of NIV, and adherence to treatment were similar when compared to younger subjects, confirming the feasibility of long-term NIV in the very old. Health-related quality of life was not assessed in this study and further research is needed to address this issue.
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http://dx.doi.org/10.3389/fmed.2020.556218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686650PMC
November 2020

[Diagnostic approach to chronic dyspnea in adults].

Rev Med Suisse 2020 Nov;16(715):2198-2203

Service de Pneumologie, HUG, 1211 Genève 14.

Dyspnea is a symptom resulting from a complex interaction between multiple mechanisms that are not fully understood to this day. Chronic dyspnea is defined as dyspnea lasting more than one month and this symptom is commonly seen in primary care. Cardio-respiratory pathologies account for approximately 85 % of all cases of dyspnea. Dyspnea significantly impacts the quality of life of the affected patients and is a good predictor of morbidity and mortality. Chronic dyspnea is challenging, especially when the etiology is unclear. Performing pulmonary function tests (PFTs) and a cardiopulmonary exercise test (CPET) allows to better understand the pathophysiology of the dyspnea in order to guide the diagnosis.
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November 2020

Acute lupus pneumonitis as the initial presentation of systemic lupus erythematosus.

BMJ Case Rep 2020 Jul 7;13(7). Epub 2020 Jul 7.

Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland.

Systemic lupus erythematosus is a multisystem autoimmune disease with wide-ranging pleuropulmonary manifestations. Acute lupus pneumonitis is one of its uncommon complications. We report a 36-year-old woman with acute lupus pneumonitis as the initial presentation of systemic lupus erythematosus. Clinical, biological, radiological and functional improvements were noticed with the administration of steroids, hydroxychloroquine and immunoglobulin.
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http://dx.doi.org/10.1136/bcr-2020-234638DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342476PMC
July 2020

Adaptive Servo-Ventilation: A Comprehensive Descriptive Study in the Geneva Lake Area.

Front Med (Lausanne) 2020 3;7:105. Epub 2020 Apr 3.

Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Use of adaptive servo-ventilation (ASV) has been questioned in patients with central sleep apnea (CSA) and chronic heart failure (CHF). This study aims to detail the present use of ASV in clinical practice. Descriptive, cross-sectional, multicentric study of patients undergoing long term (≥3 months) ASV in the Cantons of Geneva or Vaud (1,288,378 inhabitants) followed by public or private hospitals, private practitioners and/or home care providers. Patients included (458) were mostly male (392; 85.6%), overweight [BMI (median, IQR): 29 kg/m (26; 33)], comorbid, with a median age of 71 years (59-77); 84% had been treated by CPAP before starting ASV. Indications for ASV were: emergent sleep apnea (ESA; 337; 73.6%), central sleep apnea (CSA; 108; 23.6%), obstructive sleep apnea (7; 1.5%), and overlap syndrome (6; 1.3%). Origin of CSA was cardiac ( = 30), neurological ( = 26), idiopathic ( = 28), or drug-related ( = 22). Among CSA cases, 60 (56%) patients had an echocardiography within the preceding 12 months; median left ventricular ejection fraction (LVEF) was 62.5% (54-65); 11 (18%) had a LVEF ≤45%. Average daily use of ASV was [mean (SD)] 368 (140) min; 13% used their device <3:30 h. Based on ventilator software, apnea-hypopnea index was normalized in 94% of subjects with data available (94% of 428). Use of ASV has evolved from its original indication (CSA in CHF) to a heterogeneous predominantly male, aged, comorbid, and overweight population with mainly ESA or CSA. CSA in CHF represented only 6.5% of this population. Compliance and correction of respiratory events were satisfactory. www.ClinicalTrials.gov, identifier: NCT04054570.
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http://dx.doi.org/10.3389/fmed.2020.00105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145945PMC
April 2020

Long-Term Noninvasive Ventilation in the Geneva Lake Area: Indications, Prevalence, and Modalities.

Chest 2020 07 31;158(1):279-291. Epub 2020 Mar 31.

Division of Pulmonary Diseases, Geneva University Hospitals (HUG), Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland. Electronic address:

Background: Noninvasive ventilation (NIV) is standard of care for chronic hypercapnic respiratory failure, but indications, devices, and ventilatory modes are in constant evolution.

Research Question: To describe changes in prevalence and indications for NIV over a 15-year period; to provide a comprehensive report of characteristics of the population treated (age, comorbidities, and anthropometric data), mode of implementation and follow-up, devices, modes and settings used, physiological data, compliance, and data from ventilator software.

Study Design And Methods: Cross-sectional observational study designed to include all subjects under NIV followed by all structures involved in NIV in the Cantons of Geneva and Vaud (1,288,378 inhabitants).

Results: A total of 489 patients under NIV were included. Prevalence increased 2.5-fold since 2000 reaching 38 per 100,000 inhabitants. Median age was 71 years, with 31% being > 75 years of age. Patients had been under NIV for a median of 39 months and had an average of 3 ± 1.8 comorbidities; 55% were obese. COPD (including overlap syndrome) was the most important patient group, followed by obesity hypoventilation syndrome (OHS) (26%). Daytime Paco was most often normalized. Adherence to treatment was satisfactory, with 8% only using their device < 3.5 h/d. Bilevel positive pressure ventilators in spontaneous/timed mode was the default mode (86%), with a low use of autotitrating modes. NIV was initiated electively in 50% of the population, in a hospital setting in 82%, and as outpatients in 15%.

Interpretation: Use of NIV is increasing rapidly in this area, and the population treated is aging, comorbid, and frequently obese. COPD is presently the leading indication followed by OHS.

Trial Registry: ClinicalTrials.gov; No.: NCT04054570; URL: www.clinicaltrials.gov.
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http://dx.doi.org/10.1016/j.chest.2020.02.064DOI Listing
July 2020

Can Early Introduction of Palliative Care Limit Intensive Care, Emergency and Hospital Admissions in Patients with Severe Chronic Obstructive Pulmonary Disease? A Pilot Randomized Study.

Respiration 2019;97(5):406-415. Epub 2019 Jan 16.

Department of Community Medicine, Primary Care, and Emergency, Geneva University Hospitals, Geneva, Switzerland.

Background: Despite their poor prognosis, patients with severe chronic obstructive pulmonary disease (COPD) have little access to palliative care and tend to have a high rate of hospital and intensive care unit (ICU) admissions during their last year of life.

Objectives: To determine the feasibility of a home palliative care intervention during 1 year versus usual care, and the possible impact of this intervention on emergency, hospital and ICU admissions, survival, mood, and health-related quality of life (HRQL).

Methods: Prospective controlled study of patients with severe COPD (GOLD stage III or IV) and long-term oxygen therapy and/or home noninvasive ventilation and/or one or more hospital admissions in the previous year for acute exacerbation, randomized to usual care versus usual care with add-on monthly intervention by palliative care specialists at home for 12 months.

Results: Of 315 patients screened, 49 (15.5%) were randomized (26 to early palliative care; 23 to the control group); aged (mean ± SD) 71 ± 8 years; FEV1 was 37 ± 14% predicted; 88% with a COPD assessment test score > 10; 69% on long-term oxygen therapy or home noninvasive ventilation. The patients accepted the intervention and completed the assessment scales. After 1 year, there was no difference between groups in symptoms, HRQL and mood, and there was a nonsignificant trend for higher admission rates to hospital and emergency wards in the intervention group.

Conclusion: Although this pilot study was underpowered to formally exclude a benefit from palliative care in severe COPD, it raises several questions as to patient selection, reluctance to palliative care in this group, and modalities of future trials.
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http://dx.doi.org/10.1159/000495312DOI Listing
September 2020

[Current status of probiotics usage for the prevention of a first episode of Clostridium difficile infection].

Rev Med Suisse 2018 Oct;14(623):1834-1837

Service de médecine interne générale, Département de médecine interne, de réhabilitation et gériatrie, HUG, 1211 Genève 14.

Antibiotics are among the most prescribed medications worldwide and they may cause an imbalance of the gut microbiota. At the same time, the incidence of Clostridium difficile diarrhea is increasing, with significant morbidity and mortality. Probiotics are living microorganisms, bacteria or yeasts, claimed to provide health benefits when ingested in sufficient quantity. Restoration of the gut microbiota has been evaluated as a means of preventing Clostridium difficile infection. The purpose of this article is to review the most recent evidence regarding the use of probiotics in the prevention of a first episode of Clostridium difficile infection among adult patients.
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October 2018
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