Publications by authors named "Olivier Collange"

54 Publications

End-Stage Respiratory Failure Secondary to Bronchiolitis Obliterans Syndrome Induced by Toxic Epidermal Necrosis, Also Known as Lyell Syndrome: A Case Report.

Transplant Proc 2021 Apr 22. Epub 2021 Apr 22.

Strasbourg Lung Transplant Program, University Hospital, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France.

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but serious dermatologic diseases. They can be associated with systemic manifestations such as bronchiolitis obliterans syndrome (BOS). SJS/TEN-induced BOS is associated with a poor prognosis, and no guidelines exist regarding its management. Several case reports have described the association between SJS/TEN and BOS, with few patients undergoing lung transplantation as a last resort therapy. Unfortunately, in the published reports, none of the transplanted patients were observed for a long period of time after the transplantation; therefore, the long-term mortality as well as the risk of recurrence of BOS could not be inferred from these reports.

Case Report: We present the case of a young patient diagnosed with SJS complicated by BOS and end-stage respiratory failure refractory to corticosteroid therapy. She underwent bilateral lung transplantation with an outstanding outcome at 5-year follow-up.

Conclusion: SJS/TEN-induced BOS might have a favorable evolution and long-term outcomes following lung transplantation. However, prospective studies are needed to confirm this finding.
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http://dx.doi.org/10.1016/j.transproceed.2021.03.020DOI Listing
April 2021

Follow-up of COVID-19 patients: LA is transient but other aPLs are persistent.

Autoimmun Rev 2021 Apr 16;20(6):102822. Epub 2021 Apr 16.

Service d'Immunologie Clinique-Médecine Interne, Centre National de Référence des Maladies Auto-immunes et Systémiques Rares Est/Sud-Ouest RESO, Hôpitaux Universitaires de Strasbourg, France. Electronic address:

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http://dx.doi.org/10.1016/j.autrev.2021.102822DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8050395PMC
April 2021

Perioperative hemodynamic optimization: from guidelines to implementation-an experts' opinion paper.

Ann Intensive Care 2021 Apr 14;11(1):58. Epub 2021 Apr 14.

Département d'Anesthésie-Réanimation, Hôpital Bichat Claude Bernard, AP-HP Nord, Paris, France.

Despite a large body of evidence, the implementation of guidelines on hemodynamic optimization and goal-directed therapy remains limited in daily routine practice. To facilitate/accelerate this implementation, a panel of experts in the field proposes an approach based on six relevant questions/answers that are frequently mentioned by clinicians, using a critical appraisal of the literature and a modified Delphi process. The mean arterial pressure is a major determinant of organ perfusion, so that the authors unanimously recommend not to tolerate absolute values below 65 mmHg during surgery to reduce the risk of postoperative organ dysfunction. Despite well-identified limitations, the authors unanimously propose the use of dynamic indices to rationalize fluid therapy in a large number of patients undergoing non-cardiac surgery, pending the implementation of a "validity criteria checklist" before applying volume expansion. The authors recommend with a good agreement mini- or non-invasive stroke volume/cardiac output monitoring in moderate to high-risk surgical patients to optimize fluid therapy on an individual basis and avoid volume overload. The authors propose to use fluids and vasoconstrictors in combination to achieve optimal blood flow and maintain perfusion pressure above the thresholds considered at risk. Although purchase of disposable sensors and stand-alone monitors will result in additional costs, the authors unanimously acknowledge that there are data strongly suggesting this may be counterbalanced by a sustained reduction in postoperative morbidity and hospital lengths of stay. Beside existing guidelines, knowledge and explicit clinical reasoning tools followed by decision algorithms are mandatory to implement individualized hemodynamic optimization strategies and reduce postoperative morbidity and duration of hospital stay in high-risk surgical patients.
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http://dx.doi.org/10.1186/s13613-021-00845-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046882PMC
April 2021

Reduced Flow-Mediated Dilatation Is Not Related to COVID-19 Severity Three Months after Hospitalization for SARS-CoV-2 Infection.

J Clin Med 2021 Mar 23;10(6). Epub 2021 Mar 23.

Team 3072 "Mitochondria, Oxidative Stress and Muscle Protection", Unistra, Faculty of Medicine, Translational Medicine Federation of Strasbourg (FMTS), University of Strasbourg, 11 rue Humann, 67000 Strasbourg, France.

The coronavirus disease 2019 (COVID-19) pandemic has spread rapidly worldwide, with more than two million deaths. Evidence indicates the critical role of the vascular endothelium in its pathophysiology but, like potential changes in functional vasodilation, the vascular effect of SARS-CoV-2 at a given distance from the acute infection is largely unknown. We assessed brachial artery flow-mediated dilatation (FMD) in 27 COVID-19 patients needing conventional or intensive care unit hospitalization, three months after SARS-CoV-2 infection diagnosis and in nine age- and sex- matched control subjects. Interestingly, the FMD was lower in COVID-19 patients as compared to controls (8.2 (7.2-8.9) vs. 10.3 (9.1-11.7)); = 0.002, and half of the hospitalized COVID-19 survivors presented with a reduced FMD < 8% at three months of COVID-19 onset. Impaired FMD was not associated with severe or critical SARS-CoV-2 infection, reflected by ICU hospitalization, total hospitalization duration, or severity of lung damage. In conclusion, reduced FMD is often observed even three months after hospitalization for SARS-CoV-2 infection, but such alteration predominantly appears to not be related to COVID-19 severity. Longer and larger follow-up studies will help to clarify the potential prognosis value of FMD among COVID-19 patients, as well as to further determine the mechanisms involved.
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http://dx.doi.org/10.3390/jcm10061318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004847PMC
March 2021

Hemodynamic Management During Kidney Transplantation: A French Survey.

Transplant Proc 2021 Feb 6. Epub 2021 Feb 6.

Department of Nephrology and Kidney Transplantation, Nouvel Hôpital Civil, University Hospitals of Strasbourg, Strasbourg, France.

Background: Hypovolemia or excess fluid load during kidney transplantation may have detrimental effects on the recipient and graft. The aim of our survey was to examine hemodynamic monitoring during kidney transplantation (KT) in French KT centers.

Basic Procedures: The online survey covered the organization of anesthesia, the type of hemodynamic monitoring available in each center, the frequency of use of each hemodynamic parameter, and the hemodynamic algorithm used to manage fluid administration.

Main Findings: Twenty-four centers answered the survey (70% of all the 34 French KT centers) and reported performing 2029 KTs in 2016. Anesthesia for KT was performed either by a general team (n = 12, 48%) or less often, by a specific team during open hours (n = 7, 28%), a specific 24-hour/24-hour team (n = 5, 20%), or an emergency team (n = 1, 4%). The centers reported that up to 8 different hemodynamic monitoring techniques were available for KT. Central venous pressure (CVP) is the most frequently used hemodynamic parameter (1278 KT, 63%). Among the 17 centers using CVP monitoring, 9 had no specific algorithm and the other 8 centers used a different algorithm to manage fluids with CVP. The total fluids administered during KT varied from 1000 mL to 3500 mL.

Conclusions: CVP was still the main hemodynamic parameter used in France during KT in 2016. Our results suggest that a large randomized controlled trial should be performed to specifically address the question of hemodynamic management during KT.
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http://dx.doi.org/10.1016/j.transproceed.2021.01.008DOI Listing
February 2021

Risk factors and events in the adult intensive care unit associated with pain as self-reported at the end of the intensive care unit stay.

Crit Care 2020 12 7;24(1):685. Epub 2020 Dec 7.

Unité de recherche EA3279, Aix-Marseille Université, Marseille, France.

Background: The short-term and long-term consequences of the most frequent painful procedures performed in the ICU are unclear. This study aimed to identify the risk factors associated with pain-related discomfort perceived by critically ill patients during the whole ICU stay as self-reported by patients at the end of their ICU stay.

Methods: The study involved 34 ICUs. Adult patients who survived an ICU stay of 3 calendar days or more were eligible for inclusion. Discomforts, including the pain-related discomfort, were assessed using the French 18-item questionnaire on discomfort in ICU patients, the "Inconforts des Patients de REAnimation" (IPREA). Patients scored each item from 0 (minimal discomfort) to 10 (maximal discomfort). Associations between patient characteristics at ICU admission, life support therapies and main potentially painful procedures performed during the ICU stay and pain-related discomfort scores assessed at the end of the ICU stay were analyzed.

Results: Patients with complete IPREA questionnaires (n = 2130) were included. The median pain-related discomfort score was 3 (IQR 0-5). From the univariate analysis, pain-related discomfort scores were negatively correlated with age and positively correlated with ICU stay duration; surgical patients reported significant higher pain-related discomfort scores than medical patients; chest drain insertion, chest drain removal, use of bladder catheter, central venous catheter (CVC) insertion, complex dressing change, and intra-hospital transport were associated with pain-related discomfort scores. From the multivariate analyses using generalized estimating equations models, only age, chest drain removal, use of a bladder catheter, CVC insertion, and intra-hospital transport were the main risk factors associated with pain-related discomfort scores.

Conclusion: Patients who underwent chest drain removal, bladder catheter, CVC insertion, and intra-hospital transport during their ICU stay reported higher pain-related discomfort scores (with respect to the whole ICU stay and assessed at the end of their ICU stay) than patients who did not experience these events. This study may pave the way for further targeted studies aiming at investigating a causal link between these common procedures in the ICU and adult critically ill patients' perceptions of their ICU stay regarding recalled pain.

Trial Registration: Clinicaltrials.gov Identifier NCT02442934, retrospectively registered on May 13, 2015.
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http://dx.doi.org/10.1186/s13054-020-03396-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722444PMC
December 2020

Cerebrospinal Fluid Features in Patients With Coronavirus Disease 2019 and Neurological Manifestations: Correlation with Brain Magnetic Resonance Imaging Findings in 58 Patients.

J Infect Dis 2021 02;223(4):600-609

Service d'Imagerie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.

Background: Neurological manifestations are common in patients with coronavirus disease 2019 (COVID-19), but little is known about pathophysiological mechanisms. In this single-center study, we examined neurological manifestations in 58 patients, including cerebrospinal fluid (CSF) analysis and neuroimaging findings.

Methods: The study included 58 patients with COVID-19 and neurological manifestations in whom severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse-transcription polymerase chain reaction screening and on CSF analysis were performed. Clinical, laboratory, and brain magnetic resonance (MR) imaging data were retrospectively collected and analyzed.

Results: Patients were mostly men (66%), with a median age of 62 years. Encephalopathy was frequent (81%), followed by pyramidal dysfunction (16%), seizures (10%), and headaches (5%). CSF protein and albumin levels were increased in 38% and 23%, respectively. A total of 40% of patients displayed an elevated albumin quotient, suggesting impaired blood-brain barrier integrity. CSF-specific immunoglobulin G oligoclonal band was found in 5 patients (11%), suggesting an intrathecal synthesis of immunoglobulin G, and 26 patients (55%) presented identical oligoclonal bands in serum and CSF. Four patients (7%) had a positive CSF SARS-CoV-2 reverse-transcription polymerase chain reaction. Leptomeningeal enhancement was present on brain MR images in 20 patients (38%).

Conclusions: Brain MR imaging abnormalities, especially leptomeningeal enhancement, and increased inflammatory markers in CSF are frequent in patients with neurological manifestations related to COVID-19, whereas SARS-CoV-2 detection in CSF remained scanty.
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http://dx.doi.org/10.1093/infdis/jiaa745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7798956PMC
February 2021

Critical illness-associated cerebral microbleeds for patients with severe COVID-19: etiologic hypotheses.

J Neurol 2020 Nov 21. Epub 2020 Nov 21.

Hôpitaux Universitaires de Strasbourg, Service d'imagerie 2, Hôpital de Hautepierre, 1 avenue Molière, 67200, Strasbourg, France.

Background And Purpose: During the COVID-19 outbreak, the presence of extensive white matter microhemorrhages was detected by brain MRIs. The goal of this study was to investigate the origin of this atypical hemorrhagic complication.

Methods: Between March 17 and May 18, 2020, 80 patients with severe COVID-19 infections were admitted for acute respiratory distress syndrome to intensive care units at the University Hospitals of Strasbourg for whom a brain MRI for neurologic manifestations was performed. 19 patients (24%) with diffuse microhemorrhages were compared to 18 control patients with COVID-19 and normal brain MRI.

Results: The first hypothesis was hypoxemia. The latter seemed very likely since respiratory failure was longer and more pronounced in patients with microhemorrhages (prolonged endotracheal intubation (p = 0.0002), higher FiO (p = 0.03), increased use of extracorporeal membrane oxygenation (p = 0.04)). A relevant hypothesis, the role of microangiopathy, was also considered, since patients with microhemorrhages presented a higher increase of the D-Dimers (p = 0.01) and a tendency to more frequent thrombotic events (p = 0.12). Another hypothesis tested was the role of kidney failure, which was more severe in the group with diffuse microhemorrhages (higher creatinine level [median of 293 µmol/L versus 112 µmol/L, p = 0.04] and more dialysis were introduced in this group during ICU stay [12 versus 5 patients, p = 0.04]).

Conclusions: Blood-brain barrier dysfunction secondary to hypoxemia and high concentration of uremic toxins seems to be the main mechanism leading to critical illness-associated cerebral microbleeds, and this complication remains to be frequently described in severe COVID-19 patients.
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http://dx.doi.org/10.1007/s00415-020-10313-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7679237PMC
November 2020

ICU re-organisation to face the first COVID-19 epidemic wave in a tertiary hospital.

Anaesth Crit Care Pain Med 2020 Dec 1;39(6):731-732. Epub 2020 Oct 1.

Pôle Anesthésie-Réanimation & Médecine Péri-Opératoire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Équipe d'Accueil 3072, Institut de Physiologie, FMTS (Fédération de Médecine Translationnelle de Strasbourg), Faculté de Médecine, Université de Strasbourg (UNISTRA), France.

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http://dx.doi.org/10.1016/j.accpm.2020.09.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527284PMC
December 2020

Evaluation of the performance of SARS-CoV-2 serological tools and their positioning in COVID-19 diagnostic strategies.

Diagn Microbiol Infect Dis 2020 Dec 21;98(4):115181. Epub 2020 Aug 21.

Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; INSERM, UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France. Electronic address:

Rapid and accurate diagnosis is crucial for successful outbreak containment. During the current coronavirus disease 2019 (COVID-19) public health emergency, the gold standard for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnosis is the detection of viral RNA. Additional diagnostic methods õenabling the detection of current or past SARS-CoV-2 infection would be highly beneficial. We assessed 2 immunochromatographic lateral flow assays (LFA-1, LFA-2) and 2 enzyme-linked immunosorbent assay kits (IgA/IgG ELISA-1, IgM/IgG ELISA-2) using 325 samples: serum samples from polymerase chain reaction-confirmed COVID-19 hospitalized patients (n = 55) and healthcare workers (n = 143) and 127 samples from negative controls. Diagnostic performances were assessed according to days after symptom onset (dso) and the antigenic format used by manufacturers. Clinical sensitivities varied greatly among the assays, showing poor mutual agreement. After 15 dso, ELISA-1 (Euroimmun) and LFA-1 (Biosynex) combining IgM and IgG detection showed the best performances. A thorough selection of serological assays for the detection of ongoing or past infections is advisable.
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http://dx.doi.org/10.1016/j.diagmicrobio.2020.115181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7441068PMC
December 2020

Neurologic and neuroimaging findings in patients with COVID-19: A retrospective multicenter study.

Neurology 2020 09 17;95(13):e1868-e1882. Epub 2020 Jul 17.

From the Hôpitaux Universitaires de Strasbourg (S.K., F.L., S.B., F.-D.A., T.W.), Service d'imagerie 2, Hôpital de Hautepierre; Engineering Science, Computer Science and Imaging Laboratory (S.K., N.M.), UMR 7357, University of Strasbourg-CNRS; Service de Neurologie (M. Anheim), Hôpitaux Universitaires de Strasbourg; Institut de Génétique et de Biologie Moléculaire et Cellulaire (M. Anheim), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch; Fédération de Médecine Translationnelle de Strasbourg (M. Anheim), Université de Strasbourg; Hôpitaux universitaires de Strasbourg (H.M., F.M., J.H.), Service de Médecine Intensive Réanimation, Nouvel Hôpital Civil; INSERM (French National Institute of Health and Medical Research) (H.M., F.M.), UMR 1260, Regenerative Nanomedicine, Fédération de Médecine Translationnelle de Strasbourg; Médecine Intensive-Réanimation (M.S., F.S.), Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg; Service de Neuroradiologie (H.O., F.B., J.M.), Hôpitaux Civils de Colmar; Service d'Imagerie (A. Khalil, A.G.), Unité de Neuroradiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat Claude Bernard; Université Paris Diderot (A. Khalil), Paris; Service de Neurologie (S. Carré, C.L.), Centre Hospitalier de Haguenau; Service de Radiologie (M. Alleg), Centre Hospitalier de Haguenau; Service de Neuroradiologie, (E.S., R.A., F.Z.) Hôpital Central, CHU de Nancy; CHIC Unisanté (L.J., P.N., Y.T.M.), Hôpital Marie Madeleine, Forbach; Neuroimaging Department (G.H., J. Benzakoun, C.O., G. Boulouis, M.E.-G., B.K.), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Université de Paris, INSERM U1266, F-75014; CHU Rennes (J.-C.F., B.C.-N.), Department of Neuroradiology; CHU Rennes (A.M.), Medical Intensive Care Unit; Department of Neuroradiology (P.-O.C., F.R., P.T.), University Hospital of Dijon, Hôpital François Mitterrand; Service de Radiologie (C.B.), CHU de Saint-Etienne; Service de Réanimation (X.F.), CH de Roanne; Service de Neuroradiologie (G.F., S.S.), CHU de Limoges; Radiology Department (I.d.B., G. Bornet), Hôpital Privé d'Antony; Department of Diagnostic and Interventional Neuroradiology (H.D.), University Hospital, Nantes; Neuroradiology Department (J. Berge), CHU de Bordeaux; Service de Neuroradiologie (A. Kazémi), CHU de Lille; Assistance Publique Hôpitaux de Paris (N.P.), Service de Neuroradiologie, Hôpital Pitié-Salpêtrière; Sorbonne Université (N.P.), Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, F-75013; Service de Neuroradiologie Diagnostique (A.L.), Foundation A. Rothschild Hospital, Paris; EA CHIMERE 7516 (J.-M.C.), Université de Picardie Jules Verne; Service de NeuroRadiologie, pôle Imagerie Médicale, Centre Hospitalo-Universitaire d'Amiens; Hôpitaux Universitaires de Strasbourg (P.-E.Z., M.M.), UCIEC, Pôle d'Imagerie, Strasbourg; Observatoire Français de la Sclérose en Plaques (J.-C.B.), Lyon; Nephrology and Transplantation Department (S. Caillard), Hôpitaux Universitaires de Strasbourg; Inserm UMR S1109 (S. Caillard), LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg; Hôpitaux Universitaires de Strasbourg (O.C., P.M.M.), Service d'Anesthésie-Réanimation, Nouvel Hôpital Civil; Hôpitaux Universitaires de Strasbourg (S.F.-K.), Laboratoire de Virologie Médicale; Radiology Department (M.O.), Nouvel Hôpital Civil, Strasbourg University Hospital; CHU de Strasbourg (N.M.), Service de Santé Publique, GMRC, F-67091 Strasbourg; Immuno-Rhumatologie Moléculaire (S.F.-K., J.H.), INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg; MRI Center (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France.

Objective: To describe neuroimaging findings and to report the epidemiologic and clinical characteristics of patients with coronavirus disease 2019 (COVID-19) with neurologic manifestations.

Methods: In this retrospective multicenter study (11 hospitals), we included 64 patients with confirmed COVID-19 with neurologic manifestations who underwent a brain MRI.

Results: The cohort included 43 men (67%) and 21 women (33%); their median age was 66 (range 20-92) years. Thirty-six (56%) brain MRIs were considered abnormal, possibly related to severe acute respiratory syndrome coronavirus. Ischemic strokes (27%), leptomeningeal enhancement (17%), and encephalitis (13%) were the most frequent neuroimaging findings. Confusion (53%) was the most common neurologic manifestation, followed by impaired consciousness (39%), presence of clinical signs of corticospinal tract involvement (31%), agitation (31%), and headache (16%). The profile of patients experiencing ischemic stroke was different from that of other patients with abnormal brain imaging: the former less frequently had acute respiratory distress syndrome ( = 0.006) and more frequently had corticospinal tract signs ( = 0.02). Patients with encephalitis were younger ( = 0.007), whereas agitation was more frequent for patients with leptomeningeal enhancement ( = 0.009).

Conclusions: Patients with COVID-19 may develop a wide range of neurologic symptoms, which can be associated with severe and fatal complications such as ischemic stroke or encephalitis. In terms of meningoencephalitis involvement, even if a direct effect of the virus cannot be excluded, the pathophysiology seems to involve an immune or inflammatory process given the presence of signs of inflammation in both CSF and neuroimaging but the lack of virus in CSF.

Clinicaltrialsgov Identifier: NCT04368390.
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http://dx.doi.org/10.1212/WNL.0000000000010112DOI Listing
September 2020

Coronavirus Disease 2019: Associated Multiple Organ Damage.

Open Forum Infect Dis 2020 Jul 21;7(7):ofaa249. Epub 2020 Jun 21.

Service d'Anesthésie-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.

A 56-year-old man presented a particularly severe and multisystemic case of coronavirus disease 2019 (COVID-19). In addition to the common lung and quite common pulmonary embolism and kidney injuries, he presented ocular and intestinal injuries that, to our knowledge, have not been described in COVID-19 patients. Although it is difficult to make pathophysiological hypotheses about a single case, the multiplicity of injured organs argues for a systemic response to pulmonary infection. A better understanding of physiopathology should feed the discussion about therapeutic options in this type of multifocal damage related to severe acute respiratory syndrome coronavirus 2.
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http://dx.doi.org/10.1093/ofid/ofaa249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336548PMC
July 2020

In-ICU COVID-19 patients' characteristics for an estimation in post-ICU rehabilitation care requirement.

Anaesth Crit Care Pain Med 2020 08 13;39(4):479-480. Epub 2020 Jun 13.

Pôle Anesthésie Réanimation Chirurgicale, service de Réanimation Chirurgicale, Hôpitaux Universitaires de Strasbourg NHC, 67000 Strasbourg, France; EA 3072, Institut de Physiologie, FMTS (Fédération de médecine translationnelle de Strasbourg), Faculté de Médecine de Strasbourg, Université de Strasbourg, Strasbourg, France. Electronic address:

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http://dx.doi.org/10.1016/j.accpm.2020.06.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293481PMC
August 2020

Brain MRI Findings in Severe COVID-19: A Retrospective Observational Study.

Radiology 2020 11 16;297(2):E242-E251. Epub 2020 Jun 16.

From the Hôpitaux Universitaires de Strasbourg, Service d'Imagerie 2, Hôpital de Hautepierre, Strasbourg, France (S.K.).

Background Brain MRI parenchymal signal abnormalities have been associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Purpose To describe the neuroimaging findings (excluding ischemic infarcts) in patients with severe coronavirus disease 2019 (COVID-19) infection. Materials and Methods This was a retrospective study of patients evaluated from March 23, 2020, to April 27, 2020, at 16 hospitals. Inclusion criteria were () positive nasopharyngeal or lower respiratory tract reverse transcriptase polymerase chain reaction assays, () severe COVID-19 infection defined as a requirement for hospitalization and oxygen therapy, () neurologic manifestations, and () abnormal brain MRI findings. Exclusion criteria were patients with missing or noncontributory data regarding brain MRI or brain MRI showing ischemic infarcts, cerebral venous thrombosis, or chronic lesions unrelated to the current event. Categorical data were compared using the Fisher exact test. Quantitative data were compared using the Student test or Wilcoxon test. < .05 represented a significant difference. Results Thirty men (81%) and seven women (19%) met the inclusion criteria, with a mean age of 61 years ± 12 (standard deviation) (age range, 8-78 years). The most common neurologic manifestations were alteration of consciousness (27 of 37, 73%), abnormal wakefulness when sedation was stopped (15 of 37, 41%), confusion (12 of 37, 32%), and agitation (seven of 37, 19%). The most frequent MRI findings were signal abnormalities located in the medial temporal lobe in 16 of 37 patients (43%; 95% confidence interval [CI]: 27%, 59%), nonconfluent multifocal white matter hyperintense lesions seen with fluid-attenuated inversion recovery and diffusion-weighted sequences with variable enhancement, with associated hemorrhagic lesions in 11 of 37 patients (30%; 95% CI: 15%, 45%), and extensive and isolated white matter microhemorrhages in nine of 37 patients (24%; 95% CI: 10%, 38%). A majority of patients (20 of 37, 54%) had intracerebral hemorrhagic lesions with a more severe clinical presentation and a higher admission rate in intensive care units (20 of 20 patients [100%] vs 12 of 17 patients without hemorrhage [71%], = .01) and development of the acute respiratory distress syndrome (20 of 20 patients [100%] vs 11 of 17 patients [65%], = .005). Only one patient had SARS-CoV-2 RNA in the cerebrospinal fluid. Conclusion Patients with severe coronavirus disease 2019 and without ischemic infarcts had a wide range of neurologic manifestations that were associated with abnormal brain MRI scans. Eight distinctive neuroradiologic patterns were described. © RSNA, 2020.
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http://dx.doi.org/10.1148/radiol.2020202222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301613PMC
November 2020

Small bowel ischemia and SARS-CoV-2 infection: an underdiagnosed distinct clinical entity.

Surgery 2020 07 4;168(1):14-16. Epub 2020 May 4.

Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, France; IRCAD/IHU: Institute of Image-guided Surgery, Strasbourg, France.

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http://dx.doi.org/10.1016/j.surg.2020.04.035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7198136PMC
July 2020

Acute Pulmonary Embolism in Patients with COVID-19 at CT Angiography and Relationship to d-Dimer Levels.

Radiology 2020 09 23;296(3):E189-E191. Epub 2020 Apr 23.

From the Hôpitaux Universitaires de Strasbourg, Service de Radiologie, Nouvel Hôpital Civil, 1 place de l'Hôpital, 67000, Strasbourg, France (I.L.L., A.L., P.L., C.R., M.O.); Hôpitaux Universitaires de Strasbourg, Service de Réanimation Polyvalente, Nouvel Hôpital Civil, Strasbourg, France (X.D., C.P., O.C.); Hôpitaux universitaires de Strasbourg, Groupe Méthodes en Recherche Clinique (GMRC), Hôpital Civil, Strasbourg, France (F. Séverac); Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive et Réanimation, Nouvel Hôpital Civil, Strasbourg, France (J.H.); ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Strasbourg, France (J.H.); Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Hôpital de Hautepierre I, Strasbourg, France (F. Schneider); Hôpitaux Universitaires de Strasbourg, Service d'Accueil des Urgences, Nouvel Hôpital Civil, Strasbourg, France (P.B.); and Hôpitaux Universitaires de Strasbourg, Service de Radiologie, Hôpital de Hautepierre I, Strasbourg, France (S.M.).

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http://dx.doi.org/10.1148/radiol.2020201561DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233397PMC
September 2020

Liberal or Conservative Oxygen Therapy for Acute Respiratory Distress Syndrome.

N Engl J Med 2020 03;382(11):999-1008

From the Medical Intensive Care Unit (L.B., H.W., L.V., G.C.), the Anesthesia and Intensive Care Unit (L.B., S.P.-F.), Unité de Méthodologie, INSERM Clinical Investigation Center 1431, University Hospital (F. Mauny, M.P.), and Research Unit EA3920, Université de Franche Comté (L.B., H.W. S.P.-F., G.C.), Besançon, the Medical Intensive Care Unit, University Hospital of Angers, Angers (P.A.), the Intensive Care Unit, General Hospital of Avignon, Avignon (F. Montini), the Intensive Care Unit, General Hospital of Nord Franche-Comté, Trévenans (J.B.), the Medical Intensive Care Unit (J.-P.Q.) and the Anesthesia and Intensive Care Unit (B.B.), University Hospital of Dijon, Dijon, the Intensive Care Unit, General Hospital of Metz-Thionville, Metz (G.L.), the Medical Intensive Care Unit (B.S.) and the Anesthesia and Intensive Care Unit (J.-M.C.), University Hospital of Clermont-Ferrand, Clermont-Ferrand, the Anesthesia and Intensive Care Unit, University Hospital of Strasbourg, Strasbourg (O.C., J.P.), and the Medical Intensive Care Unit, University Hospital of Nancy, Nancy (B.L.) - all in France; and the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (G.C.).

Background: In patients with acute respiratory distress syndrome (ARDS), the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network recommends a target partial pressure of arterial oxygen (Pao) between 55 and 80 mm Hg. Prospective validation of this range in patients with ARDS is lacking. We hypothesized that targeting the lower limit of this range would improve outcomes in patients with ARDS.

Methods: In this multicenter, randomized trial, we assigned patients with ARDS to receive either conservative oxygen therapy (target Pao, 55 to 70 mm Hg; oxygen saturation as measured by pulse oximetry [Spo], 88 to 92%) or liberal oxygen therapy (target Pao, 90 to 105 mm Hg; Spo, ≥96%) for 7 days. The same mechanical-ventilation strategies were used in both groups. The primary outcome was death from any cause at 28 days.

Results: After the enrollment of 205 patients, the trial was prematurely stopped by the data and safety monitoring board because of safety concerns and a low likelihood of a significant difference between the two groups in the primary outcome. Four patients who did not meet the eligibility criteria were excluded. At day 28, a total of 34 of 99 patients (34.3%) in the conservative-oxygen group and 27 of 102 patients (26.5%) in the liberal-oxygen group had died (difference, 7.8 percentage points; 95% confidence interval [CI], -4.8 to 20.6). At day 90, 44.4% of the patients in the conservative-oxygen group and 30.4% of the patients in the liberal-oxygen group had died (difference, 14.0 percentage points; 95% CI, 0.7 to 27.2). Five mesenteric ischemic events occurred in the conservative-oxygen group.

Conclusions: Among patients with ARDS, early exposure to a conservative-oxygenation strategy with a Pao between 55 and 70 mm Hg did not increase survival at 28 days. (Funded by the French Ministry of Health; LOCO ClinicalTrials.gov number, NCT02713451.).
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http://dx.doi.org/10.1056/NEJMoa1916431DOI Listing
March 2020

Treatment with a platelet-activating factor receptor antagonist improves hemodynamics and reduces epinephrine requirements, in a lethal rodent model of anaphylactic shock.

Clin Exp Allergy 2020 03 10;50(3):383-390. Epub 2019 Dec 10.

Department of anesthesia and intensive care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.

Background: In some cases, anaphylactic shock (AS) is still lethal, despite rapid use of epinephrine. High doses of epinephrine are associated with severe complications. Platelet-activating factor (PAF) is secreted in massive amounts during AS, and a high plasma level is correlated with increased AS severity.

Objective: To assess the effect of ABT-491, a PAF-receptor antagonist and possible adjunct treatment, alone or in combination with epinephrine during AS.

Methods: AS was induced by intravenous injection of 1 mg ovalbumin into ovalbumin-sensitized rats. Rats were then randomly assigned to 5 groups (n = 10 per group): SHAM (vehicle only), SHOCK (no treatment), ABT (ABT-491 1 mg/kg), EPI (epinephrine 5 µg as a bolus then 10 µg kg  min by continuous infusion, followed by a reducing protocol) and EPI-ABT (both treatments).

Results: Ovalbumin injection resulted in a severe decrease in mean arterial pressure, left ventricular inotropy (max dP/dt) and left ventricular shortening fraction (LVSF). All rats from the ABT group survived until the end of the experiment. ABT-491 prevented the LVSF decrease observed in the SHOCK group (at T15: ABT 50% ± 11% vs SHOCK 36% ± 9%, P = .01), significantly reduced the dose of epinephrine needed to treat anaphylactic shock (EPI-ABT 314 ± 67 µg/kg vs EPI 475 ± 69 µg/kg, P < .001) and reduced the time to restore basal MAP (ABT 23 ± 7 minutes vs EPI-ABT 13 ± 5 minutes, P < .01).

Conclusions And Clinical Relevance: AS was characterized by early cardiac dysfunction in our model. Treatment with ABT-491 allowed survival until the end of the experiment and reduced cardiac dysfunction. Use of the PAF-R antagonist had a synergistic effect with epinephrine and allowed a significant reduction in epinephrine consumption. Use of PAF-R antagonists during AS could reduce epinephrine-related complications and improve the treatment of epinephrine refractory cases.
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http://dx.doi.org/10.1111/cea.13540DOI Listing
March 2020

Assessment of patients' self-perceived intensive care unit discomforts: Validation of the 18-item version of the IPREA.

Health Qual Life Outcomes 2019 Feb 7;17(1):29. Epub 2019 Feb 7.

Réanimation polyvalente, Hôpital Louis Pasteur, CH de Chartres, Le Coudray, France.

Background And Aims: We reported the validation of the 18-item version of the 'Inconforts des Patients de REAnimation (IPREA)' questionnaire that includes 2 new items exploring feeling depressed and shortness of breath during an intensive care unit (ICU) stay.

Methods: The validation process was integrated in a multicenter, cluster-randomized, controlled, two-parallel group study built to assess the effectiveness of a tailored multicomponent program for reducing self-perceived discomfort in the ICU. All patients aged 18 years or older who survived an ICU stay of 3 calendar days or more were eligible for inclusion. Data collection included demographics (sex, age), type of admission (medical and surgical), health status scores at admission (Knaus score and McCabe index, Simplified Acute Physiology Score (SAPS) II), specific ICU therapeutics such as mechanical ventilation (MV), noninvasive ventilation (NIV), use of vasopressors, or renal replacement therapy (RRT), and ICU stay duration.

Results: A total of 994 patients were included. The initial structure of IPREA was confirmed using confirmatory factor analysis showing satisfactory fit (RMSEA at 0.042, CFI at 0.912). No multidimensional structure was identified, allowing the calculation of an overall discomfort score. The three highest discomforts were sleep deprivation, thirst, and perfusion lines and other devices, and the 3 lowest discomforts were limited visiting hours, hunger, and isolation. The overall discomfort score of the 18-item version of IPREA did not differ between men and women. Higher age was significantly correlated with a lower overall discomfort score. While MV was not linked to self-reported discomfort, patients treated by NIV reported higher overall discomfort scores than patients not treated by NIV.

Conclusion: The 18-item version of IPREA is easy to use and possesses satisfactory psychometric properties. The availability of a reliable and valid French questionnaire asking about patients' self-perceived ICU discomforts enables feedback from the health care team to be incorporated in a continuous quality health care improvement strategy.

Trial Registration: clinicaltrial.gov NCT02442934 (registration date: May 18, 2015, retrospectively registered).
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http://dx.doi.org/10.1186/s12955-019-1101-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6367827PMC
February 2019

Tailored multicomponent program for discomfort reduction in critically ill patients may decrease post-traumatic stress disorder in general ICU survivors at 1 year.

Intensive Care Med 2019 02 30;45(2):223-235. Epub 2019 Jan 30.

Réanimation Médicale, CHU Saint-Louis, AP-HP, Paris, France.

Purpose: Reducing discomfort in the intensive care unit (ICU) should have a positive effect on long-term outcomes. This study assessed whether a tailored multicomponent program for discomfort reduction was effective in reducing post-traumatic stress disorder (PTSD) symptoms at 1 year in general ICU survivors.

Methods: This study is a prospective observational comparative effectiveness cohort study involving 30 ICUs. It was an extension of the IPREA3 study, a cluster-randomized controlled trial designed to assess the efficacy of a tailored multicomponent program to reduce discomfort in critically ill patients. The program included assessment of ICU-related self-perceived discomforts, immediate and monthly feedback to the healthcare team, and site-specific tailored interventions. The exposure was the implementation of this program. The eligible patients were exposed versus unexposed general adult ICU survivors. The prevalence of substantial PTSD symptoms at 1 year was assessed based on the Impact of Event Scale-Revised (IES-R).

Results: Of the 1537 ICU survivors included in the study, 475 unexposed patients and 344 exposed patients had follow-up data at 1 year: 57 (12.0%) and 21 (6.1%) presented with PTSD at 1 year, respectively (p = 0.004). Considering the clustering and after adjusting for age, gender, McCabe classification, and ICU-related self-perceived overall discomfort score, exposed patients were significantly less likely than unexposed patients to have substantial PTSD symptoms at 1 year (p = 0.015).

Conclusions: Implementation of a tailored multicomponent program in the ICU that has proved to be effective for reducing self-perceived discomfort in general adult ICU survivors also reduced the prevalence of substantial PTSD symptoms at 1 year.

Trial Registration: ClinicalTrials.gov identifier NCT02762409.
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http://dx.doi.org/10.1007/s00134-018-05511-yDOI Listing
February 2019

Tracheotomy in the intensive care unit: Guidelines from a French expert panel: The French Intensive Care Society and the French Society of Anaesthesia and Intensive Care Medicine.

Anaesth Crit Care Pain Med 2018 Jun 17;37(3):281-294. Epub 2018 Mar 17.

EA 3072, FMTS université de Strasbourg, 67000 Strasbourg, France; Hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, réanimation médicale, avenue Molière, 67200 Strasbourg, France. Electronic address:

Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the grading of recommendations assessment, development and evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de réanimation de langue française) and the French Society of Anesthesia and Intensive Care Medicine (Société francaise d'anesthésie réanimation) with the participation of the French Emergency Medicine Association (Société française de médecine d'urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modalities of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decannulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1±) and 6 a low level of proof (Grade 2±). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced.
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http://dx.doi.org/10.1016/j.accpm.2018.02.012DOI Listing
June 2018

Tracheotomy in the intensive care unit: guidelines from a French expert panel.

Ann Intensive Care 2018 Mar 15;8(1):37. Epub 2018 Mar 15.

EA 3072, FMTS, Université de Strasbourg, Strasbourg, France.

Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de Réanimation de Langue Française) and the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d'Anesthésie Réanimation) with the participation of the French Emergency Medicine Association (Société Française de Médecine d'Urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modalities of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decannulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1+/-) and 6 a low level of proof (Grade 2+/-). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced.
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http://dx.doi.org/10.1186/s13613-018-0381-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5854567PMC
March 2018

Adjusted calculation model of heparin management during cardiopulmonary bypass in obese patients: A randomised controlled trial.

Eur J Anaesthesiol 2018 08;35(8):613-620

From the Department of Anesthesiology and Intensive Care (MV, EH, TW, FL, CT, OC, P-MM, AS), Laboratory of Haemostasis (LG, LS), Department of Cardiac Surgery, NHC (THM) and Department of BioStatistics (FS), Federation de Medecine Translationelle, University Hospital, Strasbourg, France.

Background: Anticoagulation during cardiopulmonary bypass (CPB) is usually adapted to total body weight (TBW). This may be inaccurate in obese patients and lead to heparin overdose with a risk of bleeding.

Objectives: To validate the efficacy and safety of an adjusted calculation model of heparin dosing based on ideal body weight (IBW) rather than TBW in obese CPB patients, with an expected target mean plasma heparin concentration of 4.5 IU ml after onset of CPB in the experimental group.

Design: Randomised controlled study.

Setting: University hospital.

Patients: Sixty obese patients (BMI ≥ 30 kg m) scheduled for CPB were included from January to June 2016.

Interventions: Patients received a bolus dose of unfractionated heparin of either 300 IU kg of TBW or 340 IU kg of IBW before onset of CPB. Additional adjusted boluses were injected to maintain an activated clotting time (ACT) of at least 400 s.

Main Outcome Measures: Plasma heparin concentration and ACT were measured at different time points. Total heparin doses and transfusion requirements were recorded.

Results: The target heparin concentration of 4.5 IU ml was reached in the IBW group at the onset of CPB and maintained at all time points during CPB. Heparin concentrations were significantly higher in the TBW group after the bolus (6.52 ± 0.97 vs. 4.54 ± 1.13 IU ml, P < 0.001) and after cardioplegia (5.10 ± 1.03 vs. 4.31 ± 1.00 IU ml, P = 0.02). Total heparin doses were significantly higher in the TBW group. Mean ACT was significantly lower in the IBW group but remained over 400 s during CPB. The correlation between heparin and ACT was poor. Peri-operative bleeding and transfusion requirements were comparable. No thrombotic event occurred in the CPB circuit.

Conclusion: The current IBW-adjusted regimen of heparin administration may be used efficiently in obese CPB patients, thereby avoiding overdose which cannot be accurately assessed by ACT monitoring alone.

Trial Registration: ClinicalTrials.gov identifier: NCT02675647.
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http://dx.doi.org/10.1097/EJA.0000000000000784DOI Listing
August 2018

A tailored multicomponent program to reduce discomfort in critically ill patients: a cluster-randomized controlled trial.

Intensive Care Med 2017 Dec 27;43(12):1829-1840. Epub 2017 Nov 27.

Unité de Recherche EA3279, Aix-Marseille Université, Marseille, France.

Purpose: Critically ill patients are exposed to stressful conditions and experience several discomforts. The primary objective was to assess whether a tailored multicomponent program is effective for reducing self-perceived discomfort.

Methods: In a cluster-randomized two-arm parallel trial, 34 French adult intensive care units (ICUs) without planned interventions to reduce discomfort were randomized, 17 to the arm including a 6-month period of program implementation followed by a 6-month period without the program (experimental group), and 17 to the arm with an inversed sequence (control group). The tailored multicomponent program consisted of assessment of ICU-related self-perceived discomforts, immediate and monthly feedback to healthcare teams, and site-specific tailored interventions. The primary outcome was the overall discomfort score derived from the 16-item IPREA questionnaire (0, minimal, 100, maximal overall discomfort) and the secondary outcomes were the discomfort scores of each IPREA item. IPREA was administered on the day of ICU discharge with a considered timeframe from the ICU admission until ICU discharge.

Results: During a 1-month assessment period, 398 and 360 patients were included in the experimental group and the control group, respectively. The difference (experimental minus control) of the overall discomfort score between groups was - 7.00 (95% CI - 9.89 to - 4.11, p < 0.001). After adjustment (age, gender, ICU duration, mechanical ventilation duration, and type of admission), the program effect was still positive for the overall discomfort score (difference - 6.35, SE 1.23, p < 0.001) and for 12 out of 16 items.

Conclusions: This tailored multicomponent program decreased self-perceived discomfort in adult critically ill patients.

Trial Registration: Clinicaltrials.gov Identifier NCT02442934.
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http://dx.doi.org/10.1007/s00134-017-4991-xDOI Listing
December 2017

Epinephrine but not vasopressin attenuates the airway response to anaphylactic shock in rats.

Exp Lung Res 2017 04 25;43(3):158-166. Epub 2017 May 25.

b Service d'Anesthésie-Réanimation Chirurgicale, Pôle Anesthésie, Réanimations Chirurgicales, SAMU-SMUR, Nouvel Hôpital Civil , Hôpitaux Universitaires de Strasbourg , Strasbourg , France.

Purpose: The two life-threatening signs of anaphylactic shock (AS) are severe arterial hypotension and bronchospasm. Guidelines recommend epinephrine as first-line treatment. Arginine vasopressin (AVP) has been proposed as an alternative if epinephrine does not correct arterial hypotension. These two drugs may have beneficial, neutral or deleterious effects on airflow either directly or by modifying factors that regulate vasodilatation and/or edema in the bronchial wall.

Aim Of The Study: To compare the effects of epinephrine and AVP on airflow and airway leakage in a rat model of AS.

Materials And Methods: Thirty-two ovalbumin-sensitized rats were randomized into four groups: control (CON), AS without treatment (OVA), AS treated with epinephrine (EPI), and AS treated with AVP (AVP). Mean arterial pressure (MAP), respiratory resistance and elastance and microvascular leakage in the airways were measured.

Results: All OVA rats died within 20 minutes following ovalbumin injection. Ovalbumin induced severe arterial hypotension and airway obstruction (221 ± 36 hPa.s.L vs. vehicle 52 ± 8 hPa.s.L; p < 0.0001) associated with microvascular leakage distributed throughout the trachea, bronchi and intra-pulmonary airways. EPI and AVP extended survival time; EPI restored a higher level of MAP than AVP. Airway obstruction was attenuated by epinephrine (146 ± 19 hPa.s.L; p < 0.0001), but not by AVP (235 ± 58 hPa.s.L; p = 0.42).

Conclusions: Epinephrine was superior to AVP for alleviating the airway response in a rat model of AS. When bronchospasm and severe arterial hypotension are present during AS, epinephrine should be the drug of choice.
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http://dx.doi.org/10.1080/01902148.2017.1323981DOI Listing
April 2017

Modulation by Polymyxin-B Hemoperfusion of Inflammatory Response Related to Severe Peritonitis.

Shock 2017 01;47(1):93-99

*Service de Réanimation Médicale, Hôpital de Poitiers, Poitiers, France †INSERM CIC-P 1402 (ALIVE Group), Université de Poitiers, Poitiers, France ‡Département d'Anesthésie-Réanimation, SAMU, Hôpital Lariboisière, Paris, France §UMR INSERM 116, Université Paris 7 Denis Diderot, Paris, France ||Département d'Anesthésie-Réanimation, Hôpital Pontchaillou, Rennes, France ¶Université de Rennes, Rennes, France #Service de Réanimation, Hôpital de Roanne, Roanne, France **Département d'Anesthésie-Réanimation, Hôpital Charles Nicolle, Rouen, France ††Université de Rouen, Rouen, France ‡‡Département d'Anesthésie-Réanimation, Hôpital civil de Strasbourg, Strasbourg, France §§Université de Strasbourg, Strasbourg, France ||||Département d'Anesthésie-Réanimation, Hôpital Haut-Lévêque, Bordeaux, France ¶¶Université de Bordeaux, Bordeaux, France ##Service de Réanimation Médico-Chirurgicale, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France ***Département d'Anesthésie-Réanimation, Centre Hospitalier d'Estaing, Clermont-Ferrand, France †††Université de Clermont-Ferrand, Clermont-Ferrand, France ‡‡‡Département d'Anesthésie-Réanimation, Hôpital de Poitiers, Poitiers, France §§§Université de Poitiers, Poitiers, France ||||||Département d'Anesthésie-Réanimation, Hôpital Trousseau, Tours, France ¶¶¶Université de Tours, Tours, France ###Département d'Anesthésie-Réanimation, Hôpital Huriez, Lille, France ****Université de Lille, Lille, France ††††Service de Réanimation, Hôpital Saint-Jean, Perpignan, France ‡‡‡‡Service de Réanimation Médico-Chirurgicale, Centre Hospitalier de Saint-Malo, Saint-Malo, France §§§§Service de Réanimation Polyvalente, Centre Hospitalier de Lens, Lens, France ||||||||Service d'Immunologie et Inflammation, Hôpital de Poitiers, Poitiers, France ¶¶¶¶EA4331 LITEC, Université de Poitiers, Poitiers, France.

Conflicting results have been reported on the influence of Polymyxin-B hemoperfusion treatment on systemic inflammation markers. The aim of the study was to assess in a randomized control trial the influence on plasma cytokine concentrations of Polymyxin-B hemoperfusion in septic shock due to peritonitis. A panel of 10 pro- or anti-inflammatory cytokines was measured in 213 patients with peritonitis-induced septic shock enrolled in the randomized trial ABDOMIX testing the impact of 2 Polymyxin-B hemoperfusion sessions with standard treatment. Gram-negative bacteria were identified in 69% of patients. In the overall population, baseline plasma cytokine concentrations were not different between the two groups. Circulating tumor necrosis factor-α, interleukin (IL)-1β, IL-10, IL-6, and IL-1RA decreased significantly over time in both groups (P <0.0001 for all in controls, and P = 0.0002, 0.003, and <0.0001 in patients treated with Polymyxin-B hemoperfusion). IL-17A decreased significantly in patients treated with Polymyxin B hemoperfusion (P = 0.045) but not in controls. At the end of the second Polymyxin-B hemoperfusion session or at corresponding time in controls, plasma levels of cytokines did not differ between the two groups. Similar results were found in the subgroup of patients with gram-negative peritonitis who completed two Polymyxin-B hemoperfusion sessions. These results do not support a significant influence of Polymyxin-B hemoperfusion on circulating cytokines assessed except for IL-17A which clinical significance remains to be elucidated.
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http://dx.doi.org/10.1097/SHK.0000000000000725DOI Listing
January 2017

Comparison of capillary and arterial lactate levels in patients with shock.

Anaesth Crit Care Pain Med 2017 Jun 17;36(3):157-162. Epub 2016 Nov 17.

Pôle d'anesthésie, réanimation chirurgicale, Samu-Smur, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France.

Objective: Several guidelines recommend point-of-care lactate measurements for therapeutic decision-making in patients with shock. The aim of the study was to validate capillary lactate measurements with a bedside micromethod in patients with shock.

Study Design: Prospective observational study.

Patients And Measurements: Capillary lactate levels measured by a micromethod (CAPI) and arterial lactate levels measured by a standard laboratory method (ARTs) were simultaneously and repeatedly assayed in consecutive ICU patients with shock. The validity and clinical acceptability of the CAPI method was assessed from its reproducibility, the arterio-capillary lactate difference (ACLD) and conventional diagnostic indicators.

Main Results: Lactate measurements were available for 139 time-points in 37 patients. CAPI values correlated well with ARTs values (intraclass coefficient correlation: r=0.92, P<0.001). CAPI had a sensitivity of 98%, a specificity of 36%, an accuracy of 88% and a positive predictive value of 89% to detect lactate values≥2mmol/L (P<0.0001). The mean bias between the two methods (ACLD: 0.56±2.21mmol/L) was mainly due to higher lactate concentration in capillary blood.

Conclusion: CAPI was correctly correlated to ARTs. The bias between the two methods is probably acceptable for triage purpose. Patients with elevated capillary lactate or in shock should be monitored with atrial-based lactate.
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http://dx.doi.org/10.1016/j.accpm.2016.08.007DOI Listing
June 2017

Biventricular Takotsubo cardiomyopathy and "eclipsed" tricuspid regurgitation: insights from contrast right ventriculography.

EuroIntervention 2016 Oct 10;12(8):e1072. Epub 2016 Oct 10.

Pôle d'Activité Médico-Chirurgicale Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.

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http://dx.doi.org/10.4244/EIJV12I8A174DOI Listing
October 2016

Impact of prosthesis-patient mismatch on early haemodynamic status after aortic valve replacement.

Interact Cardiovasc Thorac Surg 2017 01 13;24(1):48-54. Epub 2016 Sep 13.

Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.

Objectives: Prosthesis-patient mismatch (PPM) has been reported to impact early haemodynamic status and early mortality after prosthetic aortic valve replacement (AVR) in patients with aortic stenosis (AS). The aim of this study was to assess the impact of PMM on early haemodynamic status after AVR using vasoactive-inotropic dependency index (VDI), postoperative pressures and end-organ perfusion.

Methods: A total of 183 patients with AS were included in this prospective cohort study, and underwent elective AVR with or without combined coronary artery bypass graft surgery. PPM was defined as a projected indexed effective orifice area of ≤0.85 cm/m, and was present in 27.9% of the patients. The primary end-point was the VDI [VDI = vasoactive-inotropic score/mean arterial pressure] measured upon admission to the intensive care unit (POD0) and on the morning of the first postoperative day (POD1). The secondary end-points were the following: mean left atrial pressure, mean central venous pressure, fluid balance, brain natriuretic peptide, troponin I, glomerular filtration rate and lactate levels on POD0 and POD1.

Results: No significant differences in VDI were observed between the no PPM and PPM groups on POD0 (0.08 ± 0.48 vs 0.05 ± 0.13, respectively, P = 0.622) or on POD1 (0.09 ± 0.40 vs 0.06 ± 0.13, respectively; P = 0.583). The mean arterial pressure, mean left atrial pressure, central venous pressure, troponin I, glomerular filtration rate and lactate levels did not differ between the two groups on POD0 and POD1, as well as fluid balance and brain natriuretic peptide on POD1.

Conclusions: PPM is not associated with early haemodynamic status impairment and end-organ perfusion after AVR.

Clinical Trial Number: ClinicalTrials.gov number, NCT00699673.
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http://dx.doi.org/10.1093/icvts/ivw303DOI Listing
January 2017