Eric Diconne - Academia.edu (original) (raw)

Papers by Eric Diconne

Research paper thumbnail of Do Contact Precautions Reduce the Incidence of Intensive Care Unit–Acquired Pseudomonas aeruginosa Infections? The DPCPYO (Detection and Contact Precautions for Patients With P. aeruginosa) Cluster-Randomized Crossover Trial

Clinical Infectious Diseases

Background The issue of contact precautions as contributory factors for reducing Pseudomonas aeru... more Background The issue of contact precautions as contributory factors for reducing Pseudomonas aeruginosa (Pa) infections in intensive care units (ICUs) remains questioned. We evaluated the impact of the addition of contact precautions to standard precautions for Pa-positive patients on incidence of ICU-acquired Pa infections. Methods In this multicenter, cluster-randomized crossover trial, 10 French ICUs were randomly assigned (1:1) to sequence 0–1 (6-month control period [CP]/3-month washout period/6-month intervention period [IP]) or sequence 1–0 (6-month IP/3-month washout period/6-month CP). A surveillance screening program for Pa was implemented. Competing-risks regression models were built with death and discharge without the occurrence of ICU-acquired Pa infection (the primary outcome) as competing events. Models were adjusted for within-ICU correlation and patient- and ICU-level covariates. The Simpson diversity index (SDI) and transmission index (TI) of Pa isolates were deri...

Research paper thumbnail of When Vitamin Deficiency Mimics Thrombotic Thrombocytopenic Purpura

Journal of the American Geriatrics Society, 2000

Research paper thumbnail of Hormonal Profile Heterogeneity and Short-Term Physical Risk in Restrictive Anorexia Nervosa

The Journal of Clinical Endocrinology & Metabolism, 2010

Context: The relevance of hormonal assessment in anorexia nervosa (AN) management is still unclea... more Context: The relevance of hormonal assessment in anorexia nervosa (AN) management is still unclear. The short-term physical risk during undernutrition period of the disease is partially predicted by anthropometric and electrolytic parameters. Objective: The objective of the study was to evaluate hormonal profiles in a large cohort of AN and their relationship with critical states. Design and Setting: This was an observational monocentric cross-sectional study performed in the endocrinological unit. Patients and Other Participants: Participants included 210 young female subjects with restrictive-type AN and 42 female controls of comparable age. Main Outcome Measures: The following hormonal parameters were measured: thyroid hormones, GH, IGF-I, cortisol, oestradiol, FSH, LH, SHBG, dehydroepiandrosterone sulfate, plasma metanephrines, and bone markers. Their relation with registered short-term evolution of AN subjects after hormonal assessment was evaluated. Results: Except for metanep...

Research paper thumbnail of Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing

Intensive Care Medicine, 2006

Evidence that PS may facilitate weaning from mechanical ventilation (MV), although not confirmed ... more Evidence that PS may facilitate weaning from mechanical ventilation (MV), although not confirmed by randomized trials, prompted us to investigate whether patients could be weaned with PS after failing a T-tube trial. This was a prospective, non-randomized study in two French intensive care units. One hundred eighteen patients were enrolled and underwent a T-tube trial, after which 87 were extubated. Thirty-one underwent a further trial with PS, after which 21 were extubated. All patients under MV >24 h meeting the criteria for a weaning test underwent a 30-min T-tube trial. If this was successful, they were immediately extubated. Otherwise, a 30-min trial with +7 cm H2O PS was initiated with an individualized pressurization slope and trigger adjustment. If all weaning criteria were met, the patients were extubated; otherwise, MV was reinstated. The extubation failure rate at 48 h did not differ significantly between the groups: 11/87 (13%) versus 4/21 (19%), P=0.39. The groups were comparable with regard to endotracheal tube diameter, MV duration, the use of non-invasive ventilation (NIV) after extubation, initial severity score, age and underlying pathology, except for COPD. A significantly higher percentage of patients with COPD was extubated after the trial with PS (8/21-38%) than after a single T-tube trial (11/87-13%) (P=0.003). Of the patients, 21/118 (18%) could be extubated after a trial with PS, despite having failed a T-tube trial. The reintubation rate was not increased. This protocol may particularly benefit patients who are most difficult to wean, notably those with COPD.

Research paper thumbnail of Pas de chirurgie sans échographie préalable en cas de thrombose veineuse superficielle clinique : à propos d’un cas d’embolie paradoxale grave

Annales Françaises d'Anesthésie et de Réanimation, 2014

Lower limbs superficial venous thrombosis (LLSVT) is usually considered as common and of a benign... more Lower limbs superficial venous thrombosis (LLSVT) is usually considered as common and of a benign prognosis. LLSVT can, however, be responsible for major thromboembolic complications: lower limbs deep vein thrombosis (LLDVT) and pulmonary embolism (PE). We report a case of a LLSVT complicated with a massive bilateral PE and an ischemic cerebral stroke, occurring immediately after a varicose vein surgery. Venous ultrasonography of the lower limbs must be systematically performed in case of LLSVT, in order to evaluate the presence of an associated LLDVT. A rigorous diagnostic and therapeutic approach is the only way to optimize the treatment of this disorder, and to avoid the occurrence of dramatic venous thromboembolic complications.

Research paper thumbnail of Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing

Intensive Care Medicine, 2006

Objective Evidence that PS may facilitate weaning from mechanical ventilation (MV), although not... more Objective Evidence that PS may facilitate weaning from mechanical ventilation (MV), although not confirmed by randomized trials, prompted us to investigate whether patients could be weaned with PS after failing a T-tube trial.Design and setting This was a prospective, non-randomized study in two French intensive care units.Patients and participants One hundred eighteen patients were enrolled and underwent a T-tube trial, after which 87

Research paper thumbnail of Uremic frost: a clinical symptom of severe azotemia

Intensive Care Medicine, 2015

Research paper thumbnail of Continuous infusion of ceftazidime in critically ill patients undergoing continuous venovenous haemodiafiltration: pharmacokinetic evaluation and dose recommendation

Critical care (London, England), 2006

In seriously infected patients with acute renal failure and who require continuous renal replacem... more In seriously infected patients with acute renal failure and who require continuous renal replacement therapy, data on continuous infusion of ceftazidime are lacking. Here we analyzed the pharmacokinetics of ceftazidime administered by continuous infusion in critically ill patients during continuous venovenous haemodiafiltration (CVVHDF) in order to identify the optimal dosage in this setting. Seven critically ill patients were prospectively enrolled in the study. CVVHDF was performed using a 0.6 m2 AN69 high-flux membrane and with blood, dialysate and ultrafiltration flow rates of 150 ml/min, 1 l/hour and 1.5 l/hour, respectively. Based on a predicted haemodiafiltration clearance of 32.5 ml/min, all patients received a 2 g loading dose of ceftazidime, followed by a 3 g/day continuous infusion for 72 hours. Serum samples were collected at 0, 3, 15 and 30 minutes and at 1, 2, 4, 6, 8, 12, 24, 36, 48 and 72 hours; dialysate/ultrafiltrate samples were taken at 2, 8, 12, 24, 36 and 48 ho...

Research paper thumbnail of Antithymocyte Globulin (ATG) Induction Therapy and Disease Recurrence in Renal Transplant Recipients With Primary IgA Nephropathy

Transplantation, 2008

Recurrence of primary IgA nephropathy after renal transplantation is clearly a time-dependent eve... more Recurrence of primary IgA nephropathy after renal transplantation is clearly a time-dependent event, justifying the use of Kaplan-Meier and Cox regression analyses to sort the significant risk factors. In this retrospective study, we focused on the potential role of induction immunosuppressive therapy. We studied 116 renal transplantation (84 males, 112 cadaveric donors, 95 first grafts, mean age at Tx=46.1 years) who received, as induction, antithymocyte globulin (ATG) in 29, anti-CD25 in 35, and none in 52, associated with different maintenance therapy overtime. The 10-year cumulative recurrence rate was overall 36%, but only 9% after ATG induction when compared with 41% without induction (P=0.001). Multivariate Cox regression confirmed that ATG was protective with a 80% reduction in relative risk (P=0.01). In conclusion, this important finding needs to be confirmed in a prospective trial and if so will have major implication.

Research paper thumbnail of Adrenal axis function does not appear to be associated with hemodynamic improvement in septic shock patients systematically receiving glucocorticoid therapy

Intensive Care Medicine, 2006

There is mounting evidence showing the value of low-dose corticosteroids in patients with septic ... more There is mounting evidence showing the value of low-dose corticosteroids in patients with septic shock requiring vasopressor therapy. It remains unclear whether adrenal function tests should be carried out systematically to guide the decision on glucocorticoid therapy. The retrospective study was conducted in 52 patients in three university hospital ICUs. We included consecutive patients with catecholamine-dependent septic shock who had not received ketoconazole, glucocorticoids, or etomidate in the 24 h before the ACTH test, and who had survived to day 3 after the shock onset. All patients had a 250-microg ACTH test before systematic glucocorticoid therapy was started. Various definitions of relative adrenal insufficiency were used (based on cortisol basal level and/or change in cortisol level after ACTH stimulation). We defined hemodynamic improvement as a 50% reduction in the vasoactive agent dose in the 3 days following the initiation of glucocorticoid treatment. The relationship between the hemodynamic improvement and the results of the adrenal function tests was analyzed. Hemodynamic improvement occurred in 29 patients (55.8%). Baseline characteristics, sites of infection, types of micro-organisms and antibiotic management did not differ between patients with and those without hemodynamic improvement. Relative adrenal insufficiency whatever the definition was not associated with hemodynamic improvement. In catecholamine-dependent septic shock patients managed with systematic glucocorticoid therapy the results of ACTH stimulation do not predict hemodynamic improvement.

Research paper thumbnail of Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing

Intensive Care Medicine, 2006

Evidence that PS may facilitate weaning from mechanical ventilation (MV), although not confirmed ... more Evidence that PS may facilitate weaning from mechanical ventilation (MV), although not confirmed by randomized trials, prompted us to investigate whether patients could be weaned with PS after failing a T-tube trial. This was a prospective, non-randomized study in two French intensive care units. One hundred eighteen patients were enrolled and underwent a T-tube trial, after which 87 were extubated. Thirty-one underwent a further trial with PS, after which 21 were extubated. All patients under MV >24 h meeting the criteria for a weaning test underwent a 30-min T-tube trial. If this was successful, they were immediately extubated. Otherwise, a 30-min trial with +7 cm H2O PS was initiated with an individualized pressurization slope and trigger adjustment. If all weaning criteria were met, the patients were extubated; otherwise, MV was reinstated. The extubation failure rate at 48 h did not differ significantly between the groups: 11/87 (13%) versus 4/21 (19%), P=0.39. The groups were comparable with regard to endotracheal tube diameter, MV duration, the use of non-invasive ventilation (NIV) after extubation, initial severity score, age and underlying pathology, except for COPD. A significantly higher percentage of patients with COPD was extubated after the trial with PS (8/21-38%) than after a single T-tube trial (11/87-13%) (P=0.003). Of the patients, 21/118 (18%) could be extubated after a trial with PS, despite having failed a T-tube trial. The reintubation rate was not increased. This protocol may particularly benefit patients who are most difficult to wean, notably those with COPD.

Research paper thumbnail of Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change

Critical Care, 2013

To assess the prevalence of dysnatremia, including borderline changes in serum sodium concentrati... more To assess the prevalence of dysnatremia, including borderline changes in serum sodium concentration, and to estimate the impact of these dysnatremia on mortality after adjustment for confounders.

Research paper thumbnail of Extremely low doses of lepirudin in a patient with heparin-induced thrombocytopenia, high bleeding risk and renal insufficiency

British Journal of Haematology, 2009

Research paper thumbnail of Pas de chirurgie sans échographie préalable en cas de thrombose veineuse superficielle clinique : à propos d’un cas d’embolie paradoxale grave

Annales Françaises d'Anesthésie et de Réanimation, 2014

Lower limbs superficial venous thrombosis (LLSVT) is usually considered as common and of a benign... more Lower limbs superficial venous thrombosis (LLSVT) is usually considered as common and of a benign prognosis. LLSVT can, however, be responsible for major thromboembolic complications: lower limbs deep vein thrombosis (LLDVT) and pulmonary embolism (PE). We report a case of a LLSVT complicated with a massive bilateral PE and an ischemic cerebral stroke, occurring immediately after a varicose vein surgery. Venous ultrasonography of the lower limbs must be systematically performed in case of LLSVT, in order to evaluate the presence of an associated LLDVT. A rigorous diagnostic and therapeutic approach is the only way to optimize the treatment of this disorder, and to avoid the occurrence of dramatic venous thromboembolic complications.

Research paper thumbnail of À propos d'un cas d'embolie graisseuse pulmonaire différée post-ostéosynthèse vertébrale

Annales Françaises d'Anesthésie et de Réanimation, 2006

A 37-year-old woman presented an acute respiratory distress syndrome six days after a post-trauma... more A 37-year-old woman presented an acute respiratory distress syndrome six days after a post-traumatic vertebral osteosynthesis. First, a pulmonary embolism was suspected, and a thrombolysis realised. This diagnosis was secondary excluded, and the diagnosis of probable fatty embolism was established by the bronchoalveolar lavage. So, this case shows a delayed presentation of fatty embolism and permits a discussion about clinical

Research paper thumbnail of WHEN VITAMIN DEFICIENCY MIMICS THROMBOTIC THROMBOCYTOPENIC PURPURA

Journal of the American Geriatrics Society, 2000

Research paper thumbnail of Do Contact Precautions Reduce the Incidence of Intensive Care Unit–Acquired Pseudomonas aeruginosa Infections? The DPCPYO (Detection and Contact Precautions for Patients With P. aeruginosa) Cluster-Randomized Crossover Trial

Clinical Infectious Diseases

Background The issue of contact precautions as contributory factors for reducing Pseudomonas aeru... more Background The issue of contact precautions as contributory factors for reducing Pseudomonas aeruginosa (Pa) infections in intensive care units (ICUs) remains questioned. We evaluated the impact of the addition of contact precautions to standard precautions for Pa-positive patients on incidence of ICU-acquired Pa infections. Methods In this multicenter, cluster-randomized crossover trial, 10 French ICUs were randomly assigned (1:1) to sequence 0–1 (6-month control period [CP]/3-month washout period/6-month intervention period [IP]) or sequence 1–0 (6-month IP/3-month washout period/6-month CP). A surveillance screening program for Pa was implemented. Competing-risks regression models were built with death and discharge without the occurrence of ICU-acquired Pa infection (the primary outcome) as competing events. Models were adjusted for within-ICU correlation and patient- and ICU-level covariates. The Simpson diversity index (SDI) and transmission index (TI) of Pa isolates were deri...

Research paper thumbnail of When Vitamin Deficiency Mimics Thrombotic Thrombocytopenic Purpura

Journal of the American Geriatrics Society, 2000

Research paper thumbnail of Hormonal Profile Heterogeneity and Short-Term Physical Risk in Restrictive Anorexia Nervosa

The Journal of Clinical Endocrinology & Metabolism, 2010

Context: The relevance of hormonal assessment in anorexia nervosa (AN) management is still unclea... more Context: The relevance of hormonal assessment in anorexia nervosa (AN) management is still unclear. The short-term physical risk during undernutrition period of the disease is partially predicted by anthropometric and electrolytic parameters. Objective: The objective of the study was to evaluate hormonal profiles in a large cohort of AN and their relationship with critical states. Design and Setting: This was an observational monocentric cross-sectional study performed in the endocrinological unit. Patients and Other Participants: Participants included 210 young female subjects with restrictive-type AN and 42 female controls of comparable age. Main Outcome Measures: The following hormonal parameters were measured: thyroid hormones, GH, IGF-I, cortisol, oestradiol, FSH, LH, SHBG, dehydroepiandrosterone sulfate, plasma metanephrines, and bone markers. Their relation with registered short-term evolution of AN subjects after hormonal assessment was evaluated. Results: Except for metanep...

Research paper thumbnail of Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing

Intensive Care Medicine, 2006

Evidence that PS may facilitate weaning from mechanical ventilation (MV), although not confirmed ... more Evidence that PS may facilitate weaning from mechanical ventilation (MV), although not confirmed by randomized trials, prompted us to investigate whether patients could be weaned with PS after failing a T-tube trial. This was a prospective, non-randomized study in two French intensive care units. One hundred eighteen patients were enrolled and underwent a T-tube trial, after which 87 were extubated. Thirty-one underwent a further trial with PS, after which 21 were extubated. All patients under MV >24 h meeting the criteria for a weaning test underwent a 30-min T-tube trial. If this was successful, they were immediately extubated. Otherwise, a 30-min trial with +7 cm H2O PS was initiated with an individualized pressurization slope and trigger adjustment. If all weaning criteria were met, the patients were extubated; otherwise, MV was reinstated. The extubation failure rate at 48 h did not differ significantly between the groups: 11/87 (13%) versus 4/21 (19%), P=0.39. The groups were comparable with regard to endotracheal tube diameter, MV duration, the use of non-invasive ventilation (NIV) after extubation, initial severity score, age and underlying pathology, except for COPD. A significantly higher percentage of patients with COPD was extubated after the trial with PS (8/21-38%) than after a single T-tube trial (11/87-13%) (P=0.003). Of the patients, 21/118 (18%) could be extubated after a trial with PS, despite having failed a T-tube trial. The reintubation rate was not increased. This protocol may particularly benefit patients who are most difficult to wean, notably those with COPD.

Research paper thumbnail of Pas de chirurgie sans échographie préalable en cas de thrombose veineuse superficielle clinique : à propos d’un cas d’embolie paradoxale grave

Annales Françaises d'Anesthésie et de Réanimation, 2014

Lower limbs superficial venous thrombosis (LLSVT) is usually considered as common and of a benign... more Lower limbs superficial venous thrombosis (LLSVT) is usually considered as common and of a benign prognosis. LLSVT can, however, be responsible for major thromboembolic complications: lower limbs deep vein thrombosis (LLDVT) and pulmonary embolism (PE). We report a case of a LLSVT complicated with a massive bilateral PE and an ischemic cerebral stroke, occurring immediately after a varicose vein surgery. Venous ultrasonography of the lower limbs must be systematically performed in case of LLSVT, in order to evaluate the presence of an associated LLDVT. A rigorous diagnostic and therapeutic approach is the only way to optimize the treatment of this disorder, and to avoid the occurrence of dramatic venous thromboembolic complications.

Research paper thumbnail of Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing

Intensive Care Medicine, 2006

Objective Evidence that PS may facilitate weaning from mechanical ventilation (MV), although not... more Objective Evidence that PS may facilitate weaning from mechanical ventilation (MV), although not confirmed by randomized trials, prompted us to investigate whether patients could be weaned with PS after failing a T-tube trial.Design and setting This was a prospective, non-randomized study in two French intensive care units.Patients and participants One hundred eighteen patients were enrolled and underwent a T-tube trial, after which 87

Research paper thumbnail of Uremic frost: a clinical symptom of severe azotemia

Intensive Care Medicine, 2015

Research paper thumbnail of Continuous infusion of ceftazidime in critically ill patients undergoing continuous venovenous haemodiafiltration: pharmacokinetic evaluation and dose recommendation

Critical care (London, England), 2006

In seriously infected patients with acute renal failure and who require continuous renal replacem... more In seriously infected patients with acute renal failure and who require continuous renal replacement therapy, data on continuous infusion of ceftazidime are lacking. Here we analyzed the pharmacokinetics of ceftazidime administered by continuous infusion in critically ill patients during continuous venovenous haemodiafiltration (CVVHDF) in order to identify the optimal dosage in this setting. Seven critically ill patients were prospectively enrolled in the study. CVVHDF was performed using a 0.6 m2 AN69 high-flux membrane and with blood, dialysate and ultrafiltration flow rates of 150 ml/min, 1 l/hour and 1.5 l/hour, respectively. Based on a predicted haemodiafiltration clearance of 32.5 ml/min, all patients received a 2 g loading dose of ceftazidime, followed by a 3 g/day continuous infusion for 72 hours. Serum samples were collected at 0, 3, 15 and 30 minutes and at 1, 2, 4, 6, 8, 12, 24, 36, 48 and 72 hours; dialysate/ultrafiltrate samples were taken at 2, 8, 12, 24, 36 and 48 ho...

Research paper thumbnail of Antithymocyte Globulin (ATG) Induction Therapy and Disease Recurrence in Renal Transplant Recipients With Primary IgA Nephropathy

Transplantation, 2008

Recurrence of primary IgA nephropathy after renal transplantation is clearly a time-dependent eve... more Recurrence of primary IgA nephropathy after renal transplantation is clearly a time-dependent event, justifying the use of Kaplan-Meier and Cox regression analyses to sort the significant risk factors. In this retrospective study, we focused on the potential role of induction immunosuppressive therapy. We studied 116 renal transplantation (84 males, 112 cadaveric donors, 95 first grafts, mean age at Tx=46.1 years) who received, as induction, antithymocyte globulin (ATG) in 29, anti-CD25 in 35, and none in 52, associated with different maintenance therapy overtime. The 10-year cumulative recurrence rate was overall 36%, but only 9% after ATG induction when compared with 41% without induction (P=0.001). Multivariate Cox regression confirmed that ATG was protective with a 80% reduction in relative risk (P=0.01). In conclusion, this important finding needs to be confirmed in a prospective trial and if so will have major implication.

Research paper thumbnail of Adrenal axis function does not appear to be associated with hemodynamic improvement in septic shock patients systematically receiving glucocorticoid therapy

Intensive Care Medicine, 2006

There is mounting evidence showing the value of low-dose corticosteroids in patients with septic ... more There is mounting evidence showing the value of low-dose corticosteroids in patients with septic shock requiring vasopressor therapy. It remains unclear whether adrenal function tests should be carried out systematically to guide the decision on glucocorticoid therapy. The retrospective study was conducted in 52 patients in three university hospital ICUs. We included consecutive patients with catecholamine-dependent septic shock who had not received ketoconazole, glucocorticoids, or etomidate in the 24 h before the ACTH test, and who had survived to day 3 after the shock onset. All patients had a 250-microg ACTH test before systematic glucocorticoid therapy was started. Various definitions of relative adrenal insufficiency were used (based on cortisol basal level and/or change in cortisol level after ACTH stimulation). We defined hemodynamic improvement as a 50% reduction in the vasoactive agent dose in the 3 days following the initiation of glucocorticoid treatment. The relationship between the hemodynamic improvement and the results of the adrenal function tests was analyzed. Hemodynamic improvement occurred in 29 patients (55.8%). Baseline characteristics, sites of infection, types of micro-organisms and antibiotic management did not differ between patients with and those without hemodynamic improvement. Relative adrenal insufficiency whatever the definition was not associated with hemodynamic improvement. In catecholamine-dependent septic shock patients managed with systematic glucocorticoid therapy the results of ACTH stimulation do not predict hemodynamic improvement.

Research paper thumbnail of Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing

Intensive Care Medicine, 2006

Evidence that PS may facilitate weaning from mechanical ventilation (MV), although not confirmed ... more Evidence that PS may facilitate weaning from mechanical ventilation (MV), although not confirmed by randomized trials, prompted us to investigate whether patients could be weaned with PS after failing a T-tube trial. This was a prospective, non-randomized study in two French intensive care units. One hundred eighteen patients were enrolled and underwent a T-tube trial, after which 87 were extubated. Thirty-one underwent a further trial with PS, after which 21 were extubated. All patients under MV >24 h meeting the criteria for a weaning test underwent a 30-min T-tube trial. If this was successful, they were immediately extubated. Otherwise, a 30-min trial with +7 cm H2O PS was initiated with an individualized pressurization slope and trigger adjustment. If all weaning criteria were met, the patients were extubated; otherwise, MV was reinstated. The extubation failure rate at 48 h did not differ significantly between the groups: 11/87 (13%) versus 4/21 (19%), P=0.39. The groups were comparable with regard to endotracheal tube diameter, MV duration, the use of non-invasive ventilation (NIV) after extubation, initial severity score, age and underlying pathology, except for COPD. A significantly higher percentage of patients with COPD was extubated after the trial with PS (8/21-38%) than after a single T-tube trial (11/87-13%) (P=0.003). Of the patients, 21/118 (18%) could be extubated after a trial with PS, despite having failed a T-tube trial. The reintubation rate was not increased. This protocol may particularly benefit patients who are most difficult to wean, notably those with COPD.

Research paper thumbnail of Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change

Critical Care, 2013

To assess the prevalence of dysnatremia, including borderline changes in serum sodium concentrati... more To assess the prevalence of dysnatremia, including borderline changes in serum sodium concentration, and to estimate the impact of these dysnatremia on mortality after adjustment for confounders.

Research paper thumbnail of Extremely low doses of lepirudin in a patient with heparin-induced thrombocytopenia, high bleeding risk and renal insufficiency

British Journal of Haematology, 2009

Research paper thumbnail of Pas de chirurgie sans échographie préalable en cas de thrombose veineuse superficielle clinique : à propos d’un cas d’embolie paradoxale grave

Annales Françaises d'Anesthésie et de Réanimation, 2014

Lower limbs superficial venous thrombosis (LLSVT) is usually considered as common and of a benign... more Lower limbs superficial venous thrombosis (LLSVT) is usually considered as common and of a benign prognosis. LLSVT can, however, be responsible for major thromboembolic complications: lower limbs deep vein thrombosis (LLDVT) and pulmonary embolism (PE). We report a case of a LLSVT complicated with a massive bilateral PE and an ischemic cerebral stroke, occurring immediately after a varicose vein surgery. Venous ultrasonography of the lower limbs must be systematically performed in case of LLSVT, in order to evaluate the presence of an associated LLDVT. A rigorous diagnostic and therapeutic approach is the only way to optimize the treatment of this disorder, and to avoid the occurrence of dramatic venous thromboembolic complications.

Research paper thumbnail of À propos d'un cas d'embolie graisseuse pulmonaire différée post-ostéosynthèse vertébrale

Annales Françaises d'Anesthésie et de Réanimation, 2006

A 37-year-old woman presented an acute respiratory distress syndrome six days after a post-trauma... more A 37-year-old woman presented an acute respiratory distress syndrome six days after a post-traumatic vertebral osteosynthesis. First, a pulmonary embolism was suspected, and a thrombolysis realised. This diagnosis was secondary excluded, and the diagnosis of probable fatty embolism was established by the bronchoalveolar lavage. So, this case shows a delayed presentation of fatty embolism and permits a discussion about clinical

Research paper thumbnail of WHEN VITAMIN DEFICIENCY MIMICS THROMBOTIC THROMBOCYTOPENIC PURPURA

Journal of the American Geriatrics Society, 2000