Publications by authors named "Thibaut Belveyre"

6 Publications

  • Page 1 of 1

Infection related catheter complications in patients undergoing prone positioning for acute respiratory distress syndrome: an exposed/unexposed study.

BMC Infect Dis 2021 Jun 7;21(1):534. Epub 2021 Jun 7.

Intensive Care Unit, Metz-Thionville Regional Hospital, Mercy Hospital, 1 allée de Château, 57085, Metz, France.

Background: Prone positioning (PP) is a standard of care for patients with moderate-severe acute respiratory distress syndrome (ARDS). While adverse events associated with PP are well-documented in the literature, research examining the effect of PP on the risk of infectious complications of intravascular catheters is lacking.

Method: All consecutive ARDS patients treated with PP were recruited retrospectively over a two-year period and formed the exposed group. Intensive care unit (ICU) patients during the same period without ARDS for whom PP was not conducted but who had an equivalent disease severity were matched 1:1 to the exposed group based on age, sex, centre, length of ICU stay and SAPS II (unexposed group). Infection-related catheter complications were defined by a composite criterion, including catheter tip colonization or intravascular catheter-related infection.

Results: A total of 101 exposed patients were included in the study. Most had direct ARDS (pneumonia). The median [Q1-Q3] PP session number was 2 [1-4]. These patients were matched with 101 unexposed patients. The mortality rates of the exposed and unexposed groups were 31 and 30%, respectively. The incidence of the composite criterion was 14.2/1000 in the exposed group compared with 8.2/1000 days in the control group (p = 0.09). Multivariate analysis identified PP as a factor related to catheter colonization or infection (p = 0.04).

Conclusion: Our data suggest that PP is associated with a higher risk of CVC infectious complications.
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June 2021

Influence of the Obesity Phenotype on the Adequacy of Antibiotic Prophylaxis with Cefoxitin for Obese Patients Undergoing Bariatric Surgery: Lessons Learnt and Future Considerations.

Eur J Drug Metab Pharmacokinet 2021 May 6. Epub 2021 May 6.

Department of Anaesthesiology, critical care and peri-operative medicine, Surgical Intensive Care Unit JM Picard, University Hospital of Nancy, 54511, Vandœuvre-Lès-Nancy, France.

Background And Objectives: A high inter-individual variability in pharmacokinetic parameters in obese patients is observed. The objective of this study was to evaluate the effect of obesity parameters on the pharmacokinetics of cefoxitin administered for antibiotic prophylaxis during bariatric surgery.

Methods: This a secondary analysis of a pharmacokinetic study involving 174 obese patients scheduled for bariatric surgery and receiving a 4-g dose of cefoxitin. Blood samples were collected at incision and wound closure. The total plasma concentrations were assessed utilising a validated high-performance liquid chromatography-tandem mass spectrometry method. The pharmacokinetic and pharmacodynamic target was defined as an estimated free concentration of cefoxitin at the time of wound closure >8 mg/L. Specific evaluated obesity parameters were fat body mass, fat body mass/height, lean body mass, lean body mass/height, visceral adipose tissue and presence of a metabolic syndrome.

Results: A total of 174 patients (median age 47 years) with a majority of women (75.3%) and a median BMI of 44 kg/m were analysed. The percentage of patients who met the pharmacokinetic and pharmacodynamic target was 85.1%. In the whole population, a tendency to fail to reach the target was observed with a higher lean mass over height [OR = 0.79; 95% CI (0.62-1.01); P = 0.060]. In the female subgroup, higher lean mass over height [OR = 0.63; 95% CI (0.41-0.97); P = 0.037] and the presence of a metabolic syndrome [OR = 0.17; 95% CI (0.03-0.83); P = 0.030] were associated with failure to reach the pharmacokinetic and pharmacodynamic target.

Conclusion: Obese patients with a higher lean mass and a metabolic syndrome could constitute a subgroup at risk for cefoxitin under-dosage.
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May 2021

Acute kidney injury in severe SARS-CoV-2 infection: An experience report in Eastern France.

Anaesth Crit Care Pain Med 2021 02 29;40(1):100788. Epub 2020 Nov 29.

Plateforme d'Appui à la Recherche Clinique, CHR Metz-Thionville Hôpital de Mercy, 57085 Metz, France.

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February 2021

Serratus Plane Block Is Effective for Pain Control in Patients With Blunt Chest Trauma: A Case Series.

Pain Pract 2020 02 31;20(2):197-203. Epub 2019 Oct 31.

Department of Anesthesiology and Critical Care, AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, Université Paris Sud, Le Kremlin Bicêtre, France.

Background: Rib fractures occur frequently following blunt chest trauma and induce morbidity and mortality. Analgesia is a cornerstone for their management, and regional analgesia is one of the tools available to reach this objective. Epidural and paravertebral blocks are the classical techniques used, but the serratus plane block (SPB) has recently been described as an effective technique for thoracic analgesia.

Methods: This case series reported and analyzed 10 consecutive cases of SPB for blunt chest trauma analgesia in a level 1 trauma center from May to October 2018. SPB was performed with either a single shot of local anesthetic or a catheter infusion.

Results: Ten patients were treated with 3 single shots and 7 catheter infusions (median length 3 days [interquartile range (IQR) 2.5 to 3.5]). The Median Injury Severity Score was 16 (IQR 16 to 23), and the number of broken ribs ranged from 3 to 22. Daily equivalent oral morphine consumption was significantly decreased after SPB from 108 mg (IQR 67 to 120) to 19 mg (IQR 0 to 58) (P = 0.015). The Numeric Pain Rating Scale (NPRS) score during cough was significantly decreased from 7.3 (IQR 5.3 to 8.8) to 4 (IQR 3.6 to 4.6) (P = 0.03). The NPRS score at rest remained unchanged. One complication occurred, due to a catheter section.

Conclusions: The SPB technique (with or without catheter insertion) in 10 patients who had blunt chest trauma with rib fractures is effective for cough pain control, with a significant decrease in morphine consumption.
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February 2020

Antibiotic prophylaxis with high-dose cefoxitin in bariatric surgery: an observational prospective single center study.

Antimicrob Agents Chemother 2019 Oct 7. Epub 2019 Oct 7.

Department of Anesthesiology and Intensive Care Medicine, University Hospital of Nancy, Vandoeuvre-Lès-Nancy F-54511, France

Background: The optimal dose of cefoxitin for antibiotic prophylaxis in obese patients remains uncertain. We evaluated the adequacy of a 4-gram dosing regimen of cefoxitin against the most frequent pathogens that infect patients undergoing bariatric surgery.

Methods: This observational prospective study included obese patients who required bariatric surgery and a 4-gram dose of cefoxitin as an antibiotic prophylaxis. Serum concentrations were measured during surgery (incision, wound closure and in case of reinjection). The pharmacokinetic/pharmacodynamic (PK/PD) target was to obtain free cefoxitin concentrations above 4× MIC, from incision to wound closure (100% ƒT). The targeted MIC was based on the worst-case scenario (the highest ECOFF value of , Enterobacteriaceae and anaerobic bacteria). The secondary outcomes were the factors related to underdosage.

Results: Two hundred patients were included. The mean age of the patients was 46 (±12) years-old, and the mean BMI was 45.8 (±6.9) kg/m Bypass surgery was the preferred technique (84%). The percentages of patients who met the PK/PD target (100% T) of cefoxitin were 37.3%, 1.1% and 0% for , Enterobacteriaceae and anaerobic bacteria, respectively. BMIs below 50 kg/m (OR 0.29, 95% CI [0.11-0.75], P = ) and a shorter duration of surgery (OR 0.97, 95% CI [0.95-0.99], P = ) were associated with reaching the target concentrations.

Conclusions: In obese patients undergoing bariatric surgery, a regimen of 4 grams of cefoxitin led to an inadequate coverage for most common pathogens. A longer surgery duration and BMI over 50 kg/m increase the risk of underdosage.
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October 2019

Spontaneous breathing during extracorporeal membrane oxygenation treatment of sickle cell disease acute chest syndrome.

Respir Med Case Rep 2019 14;28:100924. Epub 2019 Aug 14.

Service de réanimation médicale, Centre Hospitalo-Universitaire de Nancy, Vandœuvre-Lès-Nancy, F-54511, France.

Sickle cell disease (SCD) is a hereditary hemoglobinopathy resulting in sickling hemoglobin. Acute chest syndrome (ACS) is a serious complication of SCD and an important cause of morbidity and mortality. Management of ACS is complex and may necessitate mechanical ventilation and veno-venous extracorporeal membrane oxygenation (VV-ECMO) therapy in the more severe cases. We present herein the case of a young female adult (19 y.o.) with SCD who developed severe respiratory failure due to ACS occurring twice within 15 months and treated by VV-ECMO. We describe the management of ACS with VV-ECMO using two different approaches, namely with and without mechanical ventilation.
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August 2019