Publications by authors named "Paul Nolent"

6 Publications

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Experts' guidelines of intubation and extubation of the ICU patient of French Society of Anaesthesia and Intensive Care Medicine (SFAR) and French-speaking Intensive Care Society (SRLF) : In collaboration with the pediatric Association of French-speaking Anaesthetists and Intensivists (ADARPEF), French-speaking Group of Intensive Care and Paediatric emergencies (GFRUP) and Intensive Care physiotherapy society (SKR).

Ann Intensive Care 2019 Jan 22;9(1):13. Epub 2019 Jan 22.

Service USIR-SRPR, hospital de Forcilles, 77150, Férolles-Atilly, France.

Background: Intubation and extubation of ventilated patients are not risk-free procedures in the intensive care unit (ICU) and can be associated with morbidity and mortality. Intubation in the ICU is frequently required in emergency situations for patients with an unstable cardiovascular or respiratory system. Under these circumstances, it is a high-risk procedure with life-threatening complications (20-50%). Moreover, technical problems can also give rise to complications and several new techniques, such as videolaryngoscopy, have been developed recently. Another risk period is extubation, which fails in approximately 10% of cases and is associated with a poor prognosis. A better understanding of the cause of failure is essential to improve success procedure.

Results And Conclusion: In constructing these guidelines, the SFAR/SRLF experts have made use of new data on intubation and extubation in the ICU from the last decade to update existing procedures, incorporate more recent advances and propose algorithms.
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January 2019

Outbreak in newborns of methicillin-resistant Staphylococcus aureus related to the sequence type 5 Geraldine clone.

Am J Infect Control 2016 Feb 14;44(2):e9-11. Epub 2015 Nov 14.

Department of Infection Control, Groupe Hospitalier Pellegrin, University Hospital, Bordeaux, France; INSERM U657, University of Bordeaux, Bordeaux Cedex, France. Electronic address:

We describe the first nosocomial outbreak of a toxic shock syndrome-positive methicillin-resistant Staphylococcus aureus (MRSA) sequence type 5 Geraldine clone. Infection control interventions that are usually successful were implemented to control the outbreak. Spread of this virulent MRSA strain highlights the need to be vigilant to MRSA antibiotic susceptibilities.
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February 2016

Effect of high-frequency oscillation and percussion versus conventional ventilation in a piglet model of meconium aspiration.

Pediatr Pulmonol 2013 Mar 8;48(3):257-64. Epub 2012 May 8.

Université de Bordeaux2, Centre de recherche Cardio-Thoracique de Bordeaux, INSERM U1045, France.

Background: Meconium aspiration syndrome (MAS) remains a frequent cause of morbidity and mortality in term newborns. Our objective was to compare two modes of high-frequency ventilation, high-frequency oscillation (HFOV), and high-frequency percussive ventilation (HFPV) with conventional mechanical ventilation (CMV) in a piglet model of MAS.

Methods: Fifteen newborn piglets were anesthetized, paralyzed, and intubated. Following the instillation of a 3 ml/kg solution of meconium diluted to 30%, the piglets were randomized to one of three groups: high-frequency oscillation (HFOV; Sensormedics®), HFPV (Percussionaire®), or CMV (Siemens®). Animals were ventilated for 6 hr to maintain arterial blood gases within a normal range, that is, pH 7.35-7.45, PaO(2) 10-16 kPa, PaCO(2) 4-6.6 kPa. Arterial blood gas measurements, dynCrs and dynRrs, ventilator settings, and vital signs (heart rate, arterial blood pressure, transcutaneous pulse oxygen saturation, and temperature) were collected at 30, 60, 90, 120, 180, 240, 300, and 360 min after meconium instillation. Oxygenation index (OI) ([(fraction of inspired oxygen)(mean airway pressure)(100)]/PaO(2) ), mean airway pressure, dynamic lung function, secretions cleared and histological alterations were studied in all groups.

Results: Mean airway pressure and OI were significantly lower in the CV and HFPV groups compared to the HFOV group (P < 0.05). There was no significant difference between groups regarding lung function, amount of secretions and histological alterations.

Conclusion: In our model of MAS in piglets, whilst effective gas exchange with a lower mean airway pressure was possible with both CMV and HFPV compared with HFOV there was no apparent difference in lung histology or secretions.
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March 2013

Severe transient ADAMTS13 deficiency in pneumococcal-associated hemolytic uremic syndrome.

Pediatr Nephrol 2011 Apr 15;26(4):631-5. Epub 2010 Dec 15.

Service de Pédiatrie, Hôpital Pellegrin-Enfants, Centre Hospitalier Universitaire, Bordeaux, France.

Thrombotic microangiopathies comprise different entities, including hemolytic uremic syndrome (HUS), thrombotic thrombocytopenic purpura (TTP), and several other conditions. TTP is characterized by hemolytic anemia, thrombocytopenia, and multiorgan failure. TTP is the result of severe von Willebrand factor multimer cleaving protease (ADAMTS13) deficiency that is either inherited or the result of acquired autoantibodies. We report a critically ill 2-year-old girl with invasive pneumococcal disease associated HUS (p-HUS) whose condition was complicated by severe ADAMTS13 deficiency, without detectable inhibitor, in a context of multiple organ failure. The patient recovered with supportive treatment, and ADAMTS13 activity normalized without plasmatherapy. Severe ADAMTS13 deficiency appears to be a manifestation of transient endothelial cell injury in the context of severe sepsis, including invasive p-HUS. The choice of appropriate therapy should not be based on this finding.
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April 2011

Epidemiology and treatment of painful procedures in neonates in intensive care units.

JAMA 2008 Jul;300(1):60-70

Centre National de Ressources de lutte contre la Douleur, Hôpital d'enfants Armand Trousseau, 26, av du Dr Netter, 75012 Paris, France.

Context: Effective strategies to improve pain management in neonates require a clear understanding of the epidemiology and management of procedural pain.

Objective: To report epidemiological data on neonatal pain collected from a geographically defined region, based on direct bedside observation of neonates.

Design, Setting, And Patients: Between September 2005 and January 2006, data on all painful and stressful procedures and corresponding analgesic therapy from the first 14 days of admission were prospectively collected within a 6-week period from 430 neonates admitted to tertiary care centers in the Paris region of France (11.3 millions inhabitants) for the Epidemiology of Procedural Pain in Neonates (EPIPPAIN) study.

Main Outcome Measure: Number of procedures considered painful or stressful by health personnel and corresponding analgesic therapy.

Results: The mean (SD) gestational age and intensive care unit stay were 33.0 (4.6) weeks and 8.4 (4.6) calendar days, respectively. Neonates experienced 60,969 first-attempt procedures, with 42,413 (69.6%) painful and 18,556 (30.4%) stressful procedures; 11,546 supplemental attempts were performed during procedures including 10,366 (89.8%) for painful and 1180 (10.2%) for stressful procedures. Each neonate experienced a median of 115 (range, 4-613) procedures during the study period and 16 (range, 0-62) procedures per day of hospitalization. Of these, each neonate experienced a median of 75 (range, 3-364) painful procedures during the study period and 10 (range, 0-51) painful procedures per day of hospitalization. Of the 42,413 painful procedures, 2.1% were performed with pharmacological-only therapy; 18.2% with nonpharmacological-only interventions, 20.8% with pharmacological, nonpharmacological, or both types of therapy; and 79.2% without specific analgesia, and 34.2% were performed while the neonate was receiving concurrent analgesic or anesthetic infusions for other reasons. Prematurity, category of procedure, parental presence, surgery, daytime, and day of procedure after the first day of admission were associated with greater use of specific preprocedural analgesia, whereas mechanical ventilation, noninvasive ventilation and administration of nonspecific concurrent analgesia were associated with lower use of specific preprocedural analgesia.

Conclusion: During neonatal intensive care in the Paris region, large numbers of painful and stressful procedures were performed, the majority of which were not accompanied by analgesia.
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July 2008

Severe respiratory syncytial virus bronchiolitis in children: from short mechanical ventilation to extracorporeal membrane oxygenation.

Eur J Pediatr 2005 Feb 25;164(2):93-8. Epub 2004 Nov 25.

Paediatric Intensive Care Unit, Trousseau Childrens Hospital, 26 avenue du Docteur Netter, 75012 Paris, France.

Unlabelled: The objective of this study was to describe the characteristics of children who required mechanical ventilation (MV) or extracorporeal membrane oxygenation (ECMO) support for respiratory syncytial virus (RSV) bronchiolitis, and to identify risk factors associated with disease severity assessed by duration of MV, mortality and need for ECMO. Ventilated children under 1 year of age admitted for bronchiolitis were retrospectively studied over the 8-year period 1996-2003. The study population included 151 children. Of these, 38.4% were born prematurely and 8.6% had bronchopulmonary dysplasia (BPD). The mean age at initiation of MV was 61 days (+/-63 days). Infants were ventilated for a mean of 7.8 days (+/-7.5 days). Multivariate analysis revealed that prolonged duration of MV (>6 days, median value) was significantly associated with low gestational age ( P =0.02 for the group <32 weeks), requirement of neonatal oxygen supplementation ( P =0.03), BPD ( P =0.02) and positive tracheal aspiration culture ( P =0.004), in particular for Haemophilus influenzae ( P =0.03). Fourteen infants required ECMO with a mean period of MV before ECMO of 3.9 days (+/-4.5 days). Amongst these infants, the frequency of BPD was significantly higher as compared with the others ( P =0.001). Four infants died (survival rate 71.4%). The mean duration of ECMO for survivors was 12.1 days (+/-3.3 days).

Conclusion: The data suggest that gestational age, requirement of neonatal oxygen supplementation, bronchopulmonary dysplasia and tracheal colonisation with Haemophilus influenzae are correlated with prolonged mechanical ventilation in children with bronchiolitis. Only bronchopulmonary dysplasia was associated with a need for extracorporeal membrane oxygenation that may provide lifesaving support in infants refractory to conventional management.
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February 2005