Carole Ichai - Academia.edu (original) (raw)

Papers by Carole Ichai

Annales Francaises D Anesthesie Et De Reanimation, 2007

The objective of the treatment of intracranial hypertension is to decrease intracranial pressure ... more The objective of the treatment of intracranial hypertension is to decrease intracranial pressure (ICP) while maintaining cerebral blood flow (CBF). Despite numerous treatments, none of them associates total efficiency and security. Systemic secondary cerebral injuries, which are responsible for cerebral ischemia, lead us to administer non specific treatments in order to optimize CBF and cerebral oxygenation. Thus, the goals are:

Critical Care, 2010

INTRODUCTION: The purpose of this research is to provide recommendations for the management of gl... more INTRODUCTION: The purpose of this research is to provide recommendations for the management of glycemic control in critically ill patients. METHODS: Twenty-one experts issued recommendations related to one of the five pre-defined categories (glucose target, hypoglycemia, carbohydrate intake, monitoring of glycemia, algorithms and protocols), that were scored on a scale to obtain a strong or weak agreement. The GRADE (Grade

Intensive Care Medicine, 2003

Background. Despite aggressive resuscitation shock often results in multiple-organ failure charac... more Background. Despite aggressive resuscitation shock often results in multiple-organ failure characterized by increased energy demands of organs and decreased ability of effective energy production. The administration of ATP-MgCl2 as a supportive measure has been investigated in various animal models of ischemia/reperfusion injury and hemorrhagic, endotoxic, and septic shock. Investigations. These studies showed improvement in organ blood flow, microcirculation, energy balance,

Critical Care Medicine, 2002

To assess the effects of adenosine triphosphate-magnesium dichloride (ATP-MgCl2) on systemic and ... more To assess the effects of adenosine triphosphate-magnesium dichloride (ATP-MgCl2) on systemic and hepatosplanchnic hemodynamics, oxygen exchange, and energy metabolism over 24 hrs of hyperdynamic normotensive porcine endotoxemia. Prospective, randomized, controlled experimental study with repeated measures. Investigational animal laboratory. Seventeen pigs were divided into two groups: eight animals receiving endotoxin served as a control group and nine animals received endotoxin (lipopolysaccharide) and ATP-MgCl2. Pigs were anesthetized, mechanically ventilated, and instrumented. Endotoxemia was achieved by continuous intravenous infusion of Escherichia coli lipopolysaccharide. Animals were resuscitated by hetastarch targeted to maintain mean arterial pressure of >75 mm Hg. Twelve hours after the start of the endotoxin infusion, ATP-MgCl2, or its vehicle, were administered for 12 hrs. Mean arterial pressure was maintained in the control group because of a sustained increase in cardiac output achieved by fluid resuscitation, whereas ATP-MgCl2 significantly decreased mean arterial pressure because of further systemic vasodilatation. ATP-MgCl2 markedly increased portal venous flow. In contrast to the controls, hepatic arterial flow remained unchanged until the end of the experiment, despite the further increase in cardiac output. The ileal mucosal-arterial PCO2 gap (Delta PCO2) progressively increased (p <.05) in control animals, whereas it was restored to prelipopolysaccharide levels during ATP-MgCl2 infusion. Changes in Delta PCO2 correlated with those of portal vein blood flow in these animals (r = -.68, p <.05). Moreover, ATP-MgCl2 blunted the lipopolysaccharide-induced decrease in hepatic lactate balance but did not affect portal venous pH, hepatosplanchnic oxygen exchange, splanchnic lactate/pyruvate ratios, isoprostane, NO2- + NO3-, cytokine concentrations, or tissue nucleotide content. During long-term hyperdynamic porcine endotoxemia, ATP-MgCl2 normalized the otherwise progressive rise of the ileal mucosal-arterial Delta PCO2. Furthermore, it allowed blunting of the continuous decrease in hepatic lactate clearance, thus preserving the metabolic coupling between lactate release from the intestine and lactate utilization by the liver.

Anaesthesia Critical Care & Pain Medicine, 2015

In France, brain death diagnosis is regulated by law and mandates the use of confirmatory tests (... more In France, brain death diagnosis is regulated by law and mandates the use of confirmatory tests (electroencephalogram or angiography). No data are available on this practice and the possible influence of medical history. National survey using an e-mail questionnaire after phone agreement. A questionnaire was sent to intensive care units allowed to practice organ harvesting. It assessed the use of supplementary tests, the reasons behind the choice of a confirmatory test, as well as the influence of medical history on decision-making. Eighty-two out of 188 intensive care units (ICU) answered the questionnaire. Most of them (80%) performed supplementary tests, mainly transcranial Doppler. Computed tomography (CT) angiography was the only confirmatory test available in all ICUs, and this without interruption for 94% of them. Electroencephalogram (EEG) availability was usually restricted to weekdays. Most ICUs confirmed brain death by a CT-angiography (95%), less frequently by EEG (54%) and rarely by arteriography (12%). These tests were usually performed within 1 to 6hours after clinical diagnosis. Results from imaging tests were obtained within 15minutes in the majority of ICUs (59%), whereas the time for EEG results was more frequently between 15 and 60minutes (62%). The choice of confirmatory test was guided by its availability (43%), or protocol driven (20%), or a combination of both of the latter criteria (35%). Medical history had no influence on this choice for 63% of respondents. CT-angiography is currently the privileged confirmatory test for the diagnosis of brain death in France. Availability is the main reason behind this choice. The EEG is the second most commonly used test. Transcranial Doppler helps to determine when to perform confirmatory tests.

Maladies rares en réanimation, 2010

Anaesthesia Critical Care & Pain Medicine, 2015

Despite well-conducted medical treatment, refractory intracranial hypertension occurs in 10-15% o... more Despite well-conducted medical treatment, refractory intracranial hypertension occurs in 10-15% of patients with severe traumatic brain injury (TBI). Surgical decompression procedures, such as hemicraniectomy, are mainly considered as a rescue therapy. However, the long-term neurological outcomes of these patients remain controversial. Thus, the purpose of this study was to investigate the long-term evolution of patients requiring surgical decompression surgery in our ICU over the last 7years. We conducted a retrospective single-centre study over the last 7years. Severe traumatic brain injury patients presenting a refractory intracranial hypertension (ICP) and who underwent decompression surgery were included. Demographic data, in-hospital complications (infectious diseases, seizures) and in-hospital mortality were studied. Patients were further (from 1 to 8years post injury) contacted for questioning including evaluation of the Glasgow Outcome Scale (GOS), recovery of professional activity, concentration disorders, motor and mood disabilities, sleep disorders, headaches, or seizure occurrences. We compared this population with patients presenting elevated ICP not needing surgery, and matched on gender, age, SAPS II scores, initial GCS, and time since TBI. Twenty patients required decompression surgery during the studied period (2%), half of whom deceased during that time. Among surviving patients, 22% had seizures. Memory disorders represented the most frequently reported disability (100% of questioned patients). Half of the patients presented sleep disorders and headaches after hospitalization. Only 33% of these patients recovered a professional activity after treatment. Compared to the matched population, long-term neurological status was equivalent in survivors. In this small retrospective study, we found that decompression surgery performed for traumatic refractory raised ICP concerned only 2% of our traumatic brain injury patients. According to long-term evaluation, decompression surgery is associated with unfavourable outcomes and disabilities. However, the functional recovery and quality of life in survivors seems equivalent to a matched population. These results require confirmation via larger studies.

PLoS ONE, 2014

Aims: Acute kidney injury is a classical complication of diabetic ketoacidosis. However, to the b... more Aims: Acute kidney injury is a classical complication of diabetic ketoacidosis. However, to the best of our knowledge, no study has reported the incidence and characteristics of acute kidney injury since the consensus definition was issued.

Intensive Care Medicine, 2000

Objective: To evaluate the origin of H+ ions participating in the generation of CO2 coming from s... more Objective: To evaluate the origin of H+ ions participating in the generation of CO2 coming from sodium bicarbonate infusion during metabolic acidosis. We hypothesized that these H+ ions come from a back-titration of the main non-bicarbonate buffers present in the blood, i. e. the hemoglobin and the albumin, and thus postulated that the rate of CO2 release from a bicarbonate

Le point sur …, 2007

L’ischémie/reperfusion, le stress oxydant et le préconditionnement sont des phénomènes qui peuven... more L’ischémie/reperfusion, le stress oxydant et le préconditionnement sont des phénomènes qui peuvent se produire sur tous les organes. Les mécanismes généraux et les voies impliquées dans ces processus seront abordés dans un premier chapitre. L’ischémie/reperfusion et le stress oxydant représentent les mécanismes principaux de survenue de l’insuffisance rénale aiguë (IRA). La connaissance des différentes voies impliquées dans ces processus, ainsi

Annales De Chirurgie Plastique Esthetique, 2005

Necrotizing fasciitis is a bacterial dermo-hypodermitis with superficial aponevrosis necrosis due... more Necrotizing fasciitis is a bacterial dermo-hypodermitis with superficial aponevrosis necrosis due to Streptococcus pyogenes. Head and neck region are some rare localization of this infection especially after surgery. We report herein a case of a face necrotizing fasciitis following minor face surgery. A 86 year-old Caucasian male without any antecedents, nor treatment, has been operated for a fronthead spinocellular epithelioma under

Critical Care Medicine, 2000

The renal effects of dopamine in critically ill patients remain controversial. Low-dose dobutamin... more The renal effects of dopamine in critically ill patients remain controversial. Low-dose dobutamine has been reported to improve renal function. We compared the effects of various doses of dopamine and dobutamine on renal function in critically ill patients. Prospective, single-blind, randomized study. University hospital, 19-bed multidisciplinary intensive care unit. Twelve hemodynamically stable patients with mild nonoliguric renal impairment. Each patient randomly received four different doses of dopamine and dobutamine (placebo, 3, 7, and 12 microg/kg/min). Each infusion lasted for 4 hrs. Cardiac output and systemic hemodynamic variables were measured using a pulmonary arterial catheter at the beginning (HO) and the end (H4) of each infusion. The bladder was emptied at HO and H4 to determine urine volume and to collect samples. The cardiac index increased significantly with both dopamine and dobutamine (p < .001). Mean arterial pressure (MAP) increased, with the maximum effect of 20% seen with 12-microg/kg/min dopamine infusion (p < .01). No change in MAP was seen with dobutamine. Dobutamine infusions did not change any renal variables. Conversely, all dopamine infusions significantly increased diuresis, creatinine clearance, and the fractional excretion of sodium (p < .01). Creatinine clearance increased from 61+/-16.9 (SD) mL/min to a maximum of 85.7+/-30 mL/min at the 7-microg/kg/min dose; fractional excretion of sodium increased from 0.26%+/-0.28% to a maximum of 0.62%+/-0.51% at the 12-microg/kg/min dose (p < .01). During dopamine infusions, there was a significant relationship between MAP and creatinine clearance (p = .018). At all doses studied, 4-hr infusions of dopamine significantly increased creatinine clearance, diuresis, and the fractional excretion of sodium in stable critically ill patients. Conversely, dobutamine did not modify these variables. Although the level of MAP might partially contribute to the improvement in renal variables, it is more likely that the activation of renal dopamine receptors played a prominent role.

Critical Care Medicine, 2000

... critically ill patients: A single-blind, prospective, controlled study. Ichai, Carole MD; Pas... more ... critically ill patients: A single-blind, prospective, controlled study. Ichai, Carole MD; Passeron, Corinne MD; Carles, Michel MD; Bouregba, Mohammed MD; Grimaud, Dominique MD. Article Outline. Collapse Box Author Information. ...

Acute Heart Failure, 2008

This chapter discusses the different pathways of lactate metabolism and the mechanisms by which h... more This chapter discusses the different pathways of lactate metabolism and the mechanisms by which hyperlactatemia could appear during acute heart failure. The clinical practical interpretation of hyperlactatemia requires repeated lactate measurement. In all cases, it must be compared with the clinical situation and other biologic parameters. Hyperlactatemia entails a poor prognosis, especially if it is persistent. But even though it has been considered deleterious for a long time, recent data show that lactate is probably a key metabolic intermediate substrate during acute energetic crisis. Thus, hyperlactatemia, and more precisely a high lactate turnover, may be viewed as an adaptive or protective response to acute illness. Neither low pH nor hyperlactatemia requires a specific treatment (1).

Critical Care Medicine, 1997

To evaluate the effect of continuous venovenous hemofiltration with dialysis on lactate eliminati... more To evaluate the effect of continuous venovenous hemofiltration with dialysis on lactate elimination by critically ill patients. Prospective, clinical study. Surgical intensive care unit of a university hospital. Ten critically ill patients with acute renal failure and stable blood lactate concentrations. Two-stage investigation: a) measurement of lactate concentrations in samples of serum and ultradiafiltrate from patients receiving continuous venovenous hemofiltration with dialysis to calculate lactate clearance by the hemofilter; b) evaluation of total plasma lactate clearance by infusing sodium L-lactate (1 mmol/kg of body weight) over 15 mins. Arterial lactate concentration was determined before, during, and after the infusion. Lactate elimination variables were calculated from the plasma curve using model-independent and model-dependent estimates (by software). At the end of the infusion, median blood lactate concentration increased from 1.4 mmol/L (range 0.8 to 2.6) to 4.8 mmol/L (range 2.4 to 5.7) and returned to 1.6 mmol/L (range 0.9 to 3.4) 60 mins later. The median total plasma lactate clearance was 1379 mL/min (range 753.7 to 1880.7) and the median filter lactate clearance was 24.2 mL/min (range 7.1 to 35.6). Thus, filter lactate clearance accounted for < 3% of total lactate clearance. Continuous venovenous hemofiltration with dialysis cannot mask lactate overproduction, and its blood concentration remains a reliable marker of tissue oxygenation in patients receiving this renal replacement technique.

Critical Care Medicine, 1998

To evaluate the effects of hypocapnia on the systemic and hepatic circulations and oxygenation va... more To evaluate the effects of hypocapnia on the systemic and hepatic circulations and oxygenation values in patients with head injury. Open-label, prospective study. University hospital, department of anesthesiology and intensive care unit. Eleven mechanically ventilated patients with isolated head trauma and stable hemodynamic status. At the beginning of the study, each patient presented with normocapnic ventilation. Mechanical hyperventilation was then adjusted to obtain stable hypocapnia over an interval of 24 hrs. Cardiac output and other systemic hemodynamic parameters were measured, using a pulmonary artery catheter. Hepatic parameters were measured via a catheter inserted into the hepatic vein. Total hepatic blood flow was determined by the Fick principle using a continuous infusion of indocyanine green. Arterial and hepatic venous blood gases were sampled to determine systemic and hepatic-splanchnic oxygenation. Measurements were done at the end of the four phases: a) 30 mins of normocapnia (N); b) 30 mins of hypocapnia (H0); c) 3 hrs of hypocapnia (H3); and d) 24 hrs of hypocapnia (H24). Intracranial pressure and cerebral perfusion pressure were hourly monitored throughout the study. There were no significant changes in systemic hemodynamic parameters. The hepatic blood flow index did not differ from normocapnia (N 1.8 +/- 0.4 L/min/m2) to hypocapnia (H0 1.6 +/- 0.3 L/min/m2; H3 1.7 +/- 0.4 L/min/m2; H24 1.7 +/- 0.4 L/min/m2). The ratio of hepatic blood flow index to cardiac index remained stable throughout the study. Hypocapnia did not affect hepatic-splanchnic oxygen delivery and consumption. Hypocapnic hyperventilation does not alter hepatic hemodynamic parameters in patients with head injury. This result may be related to the lack of changes in cardiac output or in the hepatic vasoreactivity. Moreover, hypocapnia does not modify hepatic-splanchnic oxygenation. Thus, in case of intracranial hypertension, hypocapnia might be used without undesirable effect on the hepatic-splanchnic perfusion.

Regional Anesthesia and Pain Medicine, 2006

Several studies suggest that intrathecal morphine (ITM) improves analgesia after aortic surgery. ... more Several studies suggest that intrathecal morphine (ITM) improves analgesia after aortic surgery. We tested the hypothesis that in combination with multimodal postoperative pain management, low-dose ITM associated with general anesthesia would decrease postoperative analgesic requirements in patients undergoing abdominal aortic surgery. Thirty patients were randomized to receive either general anesthesia alone or preceded by low-dose ITM (0.2 mg) administration. Patients and providers were blinded to treatment. Postsurgical multimodal pain management was similar in both groups, including parenteral paracetamol, followed by intravenous nefopam and then morphine if not sufficient. Intravenous analgesic requirements, visual analog scale (VAS) scores, and the incidence and severity of side effects were recorded for 48 hours after surgery. Intraoperative data were comparable between the 2 groups, except sufentanil consumption, which was significantly lower in the ITM group when compared with the control group (P = .023). ITM decreased postoperative total-morphine requirements with respect to both the number of patients who received morphine (4 v 12 patients, P = .003) and the cumulative dose of morphine administered (0 [0-12.4] v 23 [13.9-45.6] mg, P = .006). VAS scores at rest were higher in the control group than in the ITM group at awakening (P < .01), at 4 hours (P < .01) after surgery, and at 8 hours (P < .05) after surgery but did not differ between groups after this period. Whereas VAS scores on coughing were higher in the control group at awakening (P < .01) and 4 hours after surgery (P < .05), no differences were found between groups from 8 hours after surgery. In patients undergoing abdominal aortic surgery, intrathecal morphine (0.2 mg) improves postoperative analgesia and decreases the need in intraoperative and postoperative analgesics. Further studies are indicated to evaluate the role of ITM in postoperative recovery.

Journal of Renal Nutrition, 2005

Lactate is a key metabolite that is produced by every cell and oxidized by most of them, provided... more Lactate is a key metabolite that is produced by every cell and oxidized by most of them, provided that they do contain mitochondria. Its metabolism is connected to energetic homeostasis and the cellular redox state. It is well recognized as an indicator of severe outcome in severely ill patients, however, it is not a detrimental factor per se. Conversely, some recent data tend even to indicate a beneficial effect in several metabolic disorders. Although the liver has long been recognized as a key organ in lactate homeostasis, the kidney also plays a major role as a gluconeogenic organ significantly involved in the glucose-lactate cycle. In acute renal failure, sodium lactate is widely used as a buffer in replacement fluids because the anion (lactate - ) is metabolized and the cation (Na + ) remains, leading to decreased water dissociation and proton concentration. The metabolic disorders related to acute renal failure or associated with it, such as liver failure, may affect lactate metabolism, and therefore they are often regarded as limiting factors for the use of lactate-containing fluids in such patients. By investigating endogenous lactate production in severe septic patients with acute renal failure, we found that an acute exogenous load of lactate did not affect the basal endogenous lactate production and metabolism. This indicates that exogenous lactate is well metabolized even in patients suffering from acute renal failure and severe sepsis with a compromised hemodynamic status.

Annales Francaises D Anesthesie Et De Reanimation, 2007

The objective of the treatment of intracranial hypertension is to decrease intracranial pressure ... more The objective of the treatment of intracranial hypertension is to decrease intracranial pressure (ICP) while maintaining cerebral blood flow (CBF). Despite numerous treatments, none of them associates total efficiency and security. Systemic secondary cerebral injuries, which are responsible for cerebral ischemia, lead us to administer non specific treatments in order to optimize CBF and cerebral oxygenation. Thus, the goals are:

Critical Care, 2010

INTRODUCTION: The purpose of this research is to provide recommendations for the management of gl... more INTRODUCTION: The purpose of this research is to provide recommendations for the management of glycemic control in critically ill patients. METHODS: Twenty-one experts issued recommendations related to one of the five pre-defined categories (glucose target, hypoglycemia, carbohydrate intake, monitoring of glycemia, algorithms and protocols), that were scored on a scale to obtain a strong or weak agreement. The GRADE (Grade

Intensive Care Medicine, 2003

Background. Despite aggressive resuscitation shock often results in multiple-organ failure charac... more Background. Despite aggressive resuscitation shock often results in multiple-organ failure characterized by increased energy demands of organs and decreased ability of effective energy production. The administration of ATP-MgCl2 as a supportive measure has been investigated in various animal models of ischemia/reperfusion injury and hemorrhagic, endotoxic, and septic shock. Investigations. These studies showed improvement in organ blood flow, microcirculation, energy balance,

Critical Care Medicine, 2002

To assess the effects of adenosine triphosphate-magnesium dichloride (ATP-MgCl2) on systemic and ... more To assess the effects of adenosine triphosphate-magnesium dichloride (ATP-MgCl2) on systemic and hepatosplanchnic hemodynamics, oxygen exchange, and energy metabolism over 24 hrs of hyperdynamic normotensive porcine endotoxemia. Prospective, randomized, controlled experimental study with repeated measures. Investigational animal laboratory. Seventeen pigs were divided into two groups: eight animals receiving endotoxin served as a control group and nine animals received endotoxin (lipopolysaccharide) and ATP-MgCl2. Pigs were anesthetized, mechanically ventilated, and instrumented. Endotoxemia was achieved by continuous intravenous infusion of Escherichia coli lipopolysaccharide. Animals were resuscitated by hetastarch targeted to maintain mean arterial pressure of >75 mm Hg. Twelve hours after the start of the endotoxin infusion, ATP-MgCl2, or its vehicle, were administered for 12 hrs. Mean arterial pressure was maintained in the control group because of a sustained increase in cardiac output achieved by fluid resuscitation, whereas ATP-MgCl2 significantly decreased mean arterial pressure because of further systemic vasodilatation. ATP-MgCl2 markedly increased portal venous flow. In contrast to the controls, hepatic arterial flow remained unchanged until the end of the experiment, despite the further increase in cardiac output. The ileal mucosal-arterial PCO2 gap (Delta PCO2) progressively increased (p <.05) in control animals, whereas it was restored to prelipopolysaccharide levels during ATP-MgCl2 infusion. Changes in Delta PCO2 correlated with those of portal vein blood flow in these animals (r = -.68, p <.05). Moreover, ATP-MgCl2 blunted the lipopolysaccharide-induced decrease in hepatic lactate balance but did not affect portal venous pH, hepatosplanchnic oxygen exchange, splanchnic lactate/pyruvate ratios, isoprostane, NO2- + NO3-, cytokine concentrations, or tissue nucleotide content. During long-term hyperdynamic porcine endotoxemia, ATP-MgCl2 normalized the otherwise progressive rise of the ileal mucosal-arterial Delta PCO2. Furthermore, it allowed blunting of the continuous decrease in hepatic lactate clearance, thus preserving the metabolic coupling between lactate release from the intestine and lactate utilization by the liver.

Anaesthesia Critical Care & Pain Medicine, 2015

In France, brain death diagnosis is regulated by law and mandates the use of confirmatory tests (... more In France, brain death diagnosis is regulated by law and mandates the use of confirmatory tests (electroencephalogram or angiography). No data are available on this practice and the possible influence of medical history. National survey using an e-mail questionnaire after phone agreement. A questionnaire was sent to intensive care units allowed to practice organ harvesting. It assessed the use of supplementary tests, the reasons behind the choice of a confirmatory test, as well as the influence of medical history on decision-making. Eighty-two out of 188 intensive care units (ICU) answered the questionnaire. Most of them (80%) performed supplementary tests, mainly transcranial Doppler. Computed tomography (CT) angiography was the only confirmatory test available in all ICUs, and this without interruption for 94% of them. Electroencephalogram (EEG) availability was usually restricted to weekdays. Most ICUs confirmed brain death by a CT-angiography (95%), less frequently by EEG (54%) and rarely by arteriography (12%). These tests were usually performed within 1 to 6hours after clinical diagnosis. Results from imaging tests were obtained within 15minutes in the majority of ICUs (59%), whereas the time for EEG results was more frequently between 15 and 60minutes (62%). The choice of confirmatory test was guided by its availability (43%), or protocol driven (20%), or a combination of both of the latter criteria (35%). Medical history had no influence on this choice for 63% of respondents. CT-angiography is currently the privileged confirmatory test for the diagnosis of brain death in France. Availability is the main reason behind this choice. The EEG is the second most commonly used test. Transcranial Doppler helps to determine when to perform confirmatory tests.

Maladies rares en réanimation, 2010

Anaesthesia Critical Care & Pain Medicine, 2015

Despite well-conducted medical treatment, refractory intracranial hypertension occurs in 10-15% o... more Despite well-conducted medical treatment, refractory intracranial hypertension occurs in 10-15% of patients with severe traumatic brain injury (TBI). Surgical decompression procedures, such as hemicraniectomy, are mainly considered as a rescue therapy. However, the long-term neurological outcomes of these patients remain controversial. Thus, the purpose of this study was to investigate the long-term evolution of patients requiring surgical decompression surgery in our ICU over the last 7years. We conducted a retrospective single-centre study over the last 7years. Severe traumatic brain injury patients presenting a refractory intracranial hypertension (ICP) and who underwent decompression surgery were included. Demographic data, in-hospital complications (infectious diseases, seizures) and in-hospital mortality were studied. Patients were further (from 1 to 8years post injury) contacted for questioning including evaluation of the Glasgow Outcome Scale (GOS), recovery of professional activity, concentration disorders, motor and mood disabilities, sleep disorders, headaches, or seizure occurrences. We compared this population with patients presenting elevated ICP not needing surgery, and matched on gender, age, SAPS II scores, initial GCS, and time since TBI. Twenty patients required decompression surgery during the studied period (2%), half of whom deceased during that time. Among surviving patients, 22% had seizures. Memory disorders represented the most frequently reported disability (100% of questioned patients). Half of the patients presented sleep disorders and headaches after hospitalization. Only 33% of these patients recovered a professional activity after treatment. Compared to the matched population, long-term neurological status was equivalent in survivors. In this small retrospective study, we found that decompression surgery performed for traumatic refractory raised ICP concerned only 2% of our traumatic brain injury patients. According to long-term evaluation, decompression surgery is associated with unfavourable outcomes and disabilities. However, the functional recovery and quality of life in survivors seems equivalent to a matched population. These results require confirmation via larger studies.

PLoS ONE, 2014

Aims: Acute kidney injury is a classical complication of diabetic ketoacidosis. However, to the b... more Aims: Acute kidney injury is a classical complication of diabetic ketoacidosis. However, to the best of our knowledge, no study has reported the incidence and characteristics of acute kidney injury since the consensus definition was issued.

Intensive Care Medicine, 2000

Objective: To evaluate the origin of H+ ions participating in the generation of CO2 coming from s... more Objective: To evaluate the origin of H+ ions participating in the generation of CO2 coming from sodium bicarbonate infusion during metabolic acidosis. We hypothesized that these H+ ions come from a back-titration of the main non-bicarbonate buffers present in the blood, i. e. the hemoglobin and the albumin, and thus postulated that the rate of CO2 release from a bicarbonate

Le point sur …, 2007

L’ischémie/reperfusion, le stress oxydant et le préconditionnement sont des phénomènes qui peuven... more L’ischémie/reperfusion, le stress oxydant et le préconditionnement sont des phénomènes qui peuvent se produire sur tous les organes. Les mécanismes généraux et les voies impliquées dans ces processus seront abordés dans un premier chapitre. L’ischémie/reperfusion et le stress oxydant représentent les mécanismes principaux de survenue de l’insuffisance rénale aiguë (IRA). La connaissance des différentes voies impliquées dans ces processus, ainsi

Annales De Chirurgie Plastique Esthetique, 2005

Necrotizing fasciitis is a bacterial dermo-hypodermitis with superficial aponevrosis necrosis due... more Necrotizing fasciitis is a bacterial dermo-hypodermitis with superficial aponevrosis necrosis due to Streptococcus pyogenes. Head and neck region are some rare localization of this infection especially after surgery. We report herein a case of a face necrotizing fasciitis following minor face surgery. A 86 year-old Caucasian male without any antecedents, nor treatment, has been operated for a fronthead spinocellular epithelioma under

Critical Care Medicine, 2000

The renal effects of dopamine in critically ill patients remain controversial. Low-dose dobutamin... more The renal effects of dopamine in critically ill patients remain controversial. Low-dose dobutamine has been reported to improve renal function. We compared the effects of various doses of dopamine and dobutamine on renal function in critically ill patients. Prospective, single-blind, randomized study. University hospital, 19-bed multidisciplinary intensive care unit. Twelve hemodynamically stable patients with mild nonoliguric renal impairment. Each patient randomly received four different doses of dopamine and dobutamine (placebo, 3, 7, and 12 microg/kg/min). Each infusion lasted for 4 hrs. Cardiac output and systemic hemodynamic variables were measured using a pulmonary arterial catheter at the beginning (HO) and the end (H4) of each infusion. The bladder was emptied at HO and H4 to determine urine volume and to collect samples. The cardiac index increased significantly with both dopamine and dobutamine (p < .001). Mean arterial pressure (MAP) increased, with the maximum effect of 20% seen with 12-microg/kg/min dopamine infusion (p < .01). No change in MAP was seen with dobutamine. Dobutamine infusions did not change any renal variables. Conversely, all dopamine infusions significantly increased diuresis, creatinine clearance, and the fractional excretion of sodium (p < .01). Creatinine clearance increased from 61+/-16.9 (SD) mL/min to a maximum of 85.7+/-30 mL/min at the 7-microg/kg/min dose; fractional excretion of sodium increased from 0.26%+/-0.28% to a maximum of 0.62%+/-0.51% at the 12-microg/kg/min dose (p < .01). During dopamine infusions, there was a significant relationship between MAP and creatinine clearance (p = .018). At all doses studied, 4-hr infusions of dopamine significantly increased creatinine clearance, diuresis, and the fractional excretion of sodium in stable critically ill patients. Conversely, dobutamine did not modify these variables. Although the level of MAP might partially contribute to the improvement in renal variables, it is more likely that the activation of renal dopamine receptors played a prominent role.

Critical Care Medicine, 2000

... critically ill patients: A single-blind, prospective, controlled study. Ichai, Carole MD; Pas... more ... critically ill patients: A single-blind, prospective, controlled study. Ichai, Carole MD; Passeron, Corinne MD; Carles, Michel MD; Bouregba, Mohammed MD; Grimaud, Dominique MD. Article Outline. Collapse Box Author Information. ...

Acute Heart Failure, 2008

This chapter discusses the different pathways of lactate metabolism and the mechanisms by which h... more This chapter discusses the different pathways of lactate metabolism and the mechanisms by which hyperlactatemia could appear during acute heart failure. The clinical practical interpretation of hyperlactatemia requires repeated lactate measurement. In all cases, it must be compared with the clinical situation and other biologic parameters. Hyperlactatemia entails a poor prognosis, especially if it is persistent. But even though it has been considered deleterious for a long time, recent data show that lactate is probably a key metabolic intermediate substrate during acute energetic crisis. Thus, hyperlactatemia, and more precisely a high lactate turnover, may be viewed as an adaptive or protective response to acute illness. Neither low pH nor hyperlactatemia requires a specific treatment (1).

Critical Care Medicine, 1997

To evaluate the effect of continuous venovenous hemofiltration with dialysis on lactate eliminati... more To evaluate the effect of continuous venovenous hemofiltration with dialysis on lactate elimination by critically ill patients. Prospective, clinical study. Surgical intensive care unit of a university hospital. Ten critically ill patients with acute renal failure and stable blood lactate concentrations. Two-stage investigation: a) measurement of lactate concentrations in samples of serum and ultradiafiltrate from patients receiving continuous venovenous hemofiltration with dialysis to calculate lactate clearance by the hemofilter; b) evaluation of total plasma lactate clearance by infusing sodium L-lactate (1 mmol/kg of body weight) over 15 mins. Arterial lactate concentration was determined before, during, and after the infusion. Lactate elimination variables were calculated from the plasma curve using model-independent and model-dependent estimates (by software). At the end of the infusion, median blood lactate concentration increased from 1.4 mmol/L (range 0.8 to 2.6) to 4.8 mmol/L (range 2.4 to 5.7) and returned to 1.6 mmol/L (range 0.9 to 3.4) 60 mins later. The median total plasma lactate clearance was 1379 mL/min (range 753.7 to 1880.7) and the median filter lactate clearance was 24.2 mL/min (range 7.1 to 35.6). Thus, filter lactate clearance accounted for < 3% of total lactate clearance. Continuous venovenous hemofiltration with dialysis cannot mask lactate overproduction, and its blood concentration remains a reliable marker of tissue oxygenation in patients receiving this renal replacement technique.

Critical Care Medicine, 1998

To evaluate the effects of hypocapnia on the systemic and hepatic circulations and oxygenation va... more To evaluate the effects of hypocapnia on the systemic and hepatic circulations and oxygenation values in patients with head injury. Open-label, prospective study. University hospital, department of anesthesiology and intensive care unit. Eleven mechanically ventilated patients with isolated head trauma and stable hemodynamic status. At the beginning of the study, each patient presented with normocapnic ventilation. Mechanical hyperventilation was then adjusted to obtain stable hypocapnia over an interval of 24 hrs. Cardiac output and other systemic hemodynamic parameters were measured, using a pulmonary artery catheter. Hepatic parameters were measured via a catheter inserted into the hepatic vein. Total hepatic blood flow was determined by the Fick principle using a continuous infusion of indocyanine green. Arterial and hepatic venous blood gases were sampled to determine systemic and hepatic-splanchnic oxygenation. Measurements were done at the end of the four phases: a) 30 mins of normocapnia (N); b) 30 mins of hypocapnia (H0); c) 3 hrs of hypocapnia (H3); and d) 24 hrs of hypocapnia (H24). Intracranial pressure and cerebral perfusion pressure were hourly monitored throughout the study. There were no significant changes in systemic hemodynamic parameters. The hepatic blood flow index did not differ from normocapnia (N 1.8 +/- 0.4 L/min/m2) to hypocapnia (H0 1.6 +/- 0.3 L/min/m2; H3 1.7 +/- 0.4 L/min/m2; H24 1.7 +/- 0.4 L/min/m2). The ratio of hepatic blood flow index to cardiac index remained stable throughout the study. Hypocapnia did not affect hepatic-splanchnic oxygen delivery and consumption. Hypocapnic hyperventilation does not alter hepatic hemodynamic parameters in patients with head injury. This result may be related to the lack of changes in cardiac output or in the hepatic vasoreactivity. Moreover, hypocapnia does not modify hepatic-splanchnic oxygenation. Thus, in case of intracranial hypertension, hypocapnia might be used without undesirable effect on the hepatic-splanchnic perfusion.

Regional Anesthesia and Pain Medicine, 2006

Several studies suggest that intrathecal morphine (ITM) improves analgesia after aortic surgery. ... more Several studies suggest that intrathecal morphine (ITM) improves analgesia after aortic surgery. We tested the hypothesis that in combination with multimodal postoperative pain management, low-dose ITM associated with general anesthesia would decrease postoperative analgesic requirements in patients undergoing abdominal aortic surgery. Thirty patients were randomized to receive either general anesthesia alone or preceded by low-dose ITM (0.2 mg) administration. Patients and providers were blinded to treatment. Postsurgical multimodal pain management was similar in both groups, including parenteral paracetamol, followed by intravenous nefopam and then morphine if not sufficient. Intravenous analgesic requirements, visual analog scale (VAS) scores, and the incidence and severity of side effects were recorded for 48 hours after surgery. Intraoperative data were comparable between the 2 groups, except sufentanil consumption, which was significantly lower in the ITM group when compared with the control group (P = .023). ITM decreased postoperative total-morphine requirements with respect to both the number of patients who received morphine (4 v 12 patients, P = .003) and the cumulative dose of morphine administered (0 [0-12.4] v 23 [13.9-45.6] mg, P = .006). VAS scores at rest were higher in the control group than in the ITM group at awakening (P < .01), at 4 hours (P < .01) after surgery, and at 8 hours (P < .05) after surgery but did not differ between groups after this period. Whereas VAS scores on coughing were higher in the control group at awakening (P < .01) and 4 hours after surgery (P < .05), no differences were found between groups from 8 hours after surgery. In patients undergoing abdominal aortic surgery, intrathecal morphine (0.2 mg) improves postoperative analgesia and decreases the need in intraoperative and postoperative analgesics. Further studies are indicated to evaluate the role of ITM in postoperative recovery.

Journal of Renal Nutrition, 2005

Lactate is a key metabolite that is produced by every cell and oxidized by most of them, provided... more Lactate is a key metabolite that is produced by every cell and oxidized by most of them, provided that they do contain mitochondria. Its metabolism is connected to energetic homeostasis and the cellular redox state. It is well recognized as an indicator of severe outcome in severely ill patients, however, it is not a detrimental factor per se. Conversely, some recent data tend even to indicate a beneficial effect in several metabolic disorders. Although the liver has long been recognized as a key organ in lactate homeostasis, the kidney also plays a major role as a gluconeogenic organ significantly involved in the glucose-lactate cycle. In acute renal failure, sodium lactate is widely used as a buffer in replacement fluids because the anion (lactate - ) is metabolized and the cation (Na + ) remains, leading to decreased water dissociation and proton concentration. The metabolic disorders related to acute renal failure or associated with it, such as liver failure, may affect lactate metabolism, and therefore they are often regarded as limiting factors for the use of lactate-containing fluids in such patients. By investigating endogenous lactate production in severe septic patients with acute renal failure, we found that an acute exogenous load of lactate did not affect the basal endogenous lactate production and metabolism. This indicates that exogenous lactate is well metabolized even in patients suffering from acute renal failure and severe sepsis with a compromised hemodynamic status.