Marc Tonnellier - Academia.edu (original) (raw)
Papers by Marc Tonnellier
Intensive Care Medicine, Nov 19, 2005
Objective: To document the prevalence of respiratory virus infections in patients with chronic ca... more Objective: To document the prevalence of respiratory virus infections in patients with chronic cardiac or pulmonary disorders admitted to a critical care unit for acute cardiorespiratory failure. Design, setting, patients: The study took place in a critical care unit during two consecutive winters. All patients admitted to the unit for acute respiratory or cardiac failure were enrolled. A nasal swab was taken for polymerase chain reaction (PCR) detection of influenza virus, respiratory syncytial virus (RSV), metapneumovirus, rhinovirus, and coronavirus. Results: One hundred twenty-two patients were enrolled. Their mean age was 69 years; 42% of the patients were female; the new simplified acute physiology score (SAPS II) score on admission was 35.6; 94% of patients had acute respiratory failure, 14% reported "influenza-like" illness before admission, and 11% of patients died in the unit. Twenty-one patients (17%) tested positive for a respiratory virus. The per-1,000 positivity rates were influenza virus 66, RSV 49, rhinovirus 33, metapneumovirus 16, and coronavirus 8. No link was found between virologic results and clinical outcome. A strong link was found between the rate of influenza virus positivity and the incidence of flulike illness in the community (p=0.017). Conclusion: These results show that respiratory virus infection-particularly influenza virus infection during epidemic periods-is common among patients hospitalized for acute cardiorespiratory failure.
![Research paper thumbnail of [Enterococcal meningitis revealing endocarditis]](https://a.academia-assets.com/images/blank-paper.jpg)
](PubMed, Jun 8, 2002
Introduction: Enterococci are frequently responsible for endocarditis, but a rare cause of mening... more Introduction: Enterococci are frequently responsible for endocarditis, but a rare cause of meningitis. Observation: A 55 years-old man presented with Enterococcus faecium meningitis. Systematic transoesophageal echocardiography (TOE), despite the absence of organic murmur and the negativity of the hemocultures, revealed a concomitant aortic endocarditis. Conclusion: Review of the literature suggests that the association of endocarditis with enterococcal meningitis is far from accidental. We suggest that a TOS be conducted systematically when faced with this disease. The therapeutic implications are important, notably regarding the duration of antibiotherapy.
Intensive Care Medicine, Jul 21, 2006
Objective: Lung tissue deposition of intravenous ceftazidime administered either continuously or ... more Objective: Lung tissue deposition of intravenous ceftazidime administered either continuously or intermittently was compared in ventilated piglets with experimental bronchopneumonia. Design: Prospective experimental study Animals: Eighteen anesthetized and ventilated piglets Interventions: Bronchopneumonia was produced by the intrabronchial inoculation of Pseudomonas aeruginosa characterized by an impaired sensitivity to ceftazidime (MIC 16 mg/l). Ceftazidime was administered either through a continuous infusion of 90 mg/kg per 24 h after a bolus of 30 mg/kg or by an intermittent infusion of 30 mg/kg per 8 h. Measurements and results: Piglets were killed 24 h after the initiation of continuous ceftazidime (n = 6), and 1 h (peak, n = 6) and 8 h (trough, n = 6) after the third dose following intermittent administration. Lung tissue concentrations of ceftazidime, measured by HPLC, and lung bacterial burden were assessed on multiple postmortem lung specimens. During continuous administration ceftazidime lung tissue concentrations were 9.7 ± 3.8 µg/g. Following intermittent administration peak and trough lung tissue concentrations were, respectively, 7.1 ± 2.4 µg/g and 0.6 ± 1 µg/g. Lung bacterial burden was different after continuous and intermittent administration (median 7.10 3 vs. 4.10 2 cfu/g). Conclusions: Continuous infusion of ceftazidime maintained higher tissue concentrations than intermittent administration.
Intensive Care Medicine, Apr 3, 2007
Objective: To assess the cardiac consequences of successful respiratory weaning using the variati... more Objective: To assess the cardiac consequences of successful respiratory weaning using the variations of circulating B-type and atrial natriuretic peptides (BNP, ANP) and Doppler mitral flow. Design: A prospective preliminary observational study. Setting: A 14-bed medical ICU in a French university hospital. Patients: Thirty-one patients undergoing a spontaneous breathing trial on a T-tube. Interventions: Circulating BNP and ANP levels and Doppler-derived E/A ratio and deceleration time of the E wave were measured before and 1 h after disconnection. Results: BNP levels increased from 299 pg/ml (range 56-1079) to 412 pg/ml (147-1324) (p = 0.02) in patients with systolic left ventricular dysfunction, decreased from 98 pg/ml (25-337) to 45 pg/ml (38-180) (p = 0.04) in patients with right ventricular dilation and remained unchanged in patients with neither of these cardiac abnormalities. Overall ANP levels increased from 33 pg/ml to 67 pg/ml (p < 0.001) regardless of ventricular function. The E/A ratio increased from 0.91 (0.66-3.56) to 1.17 (0.5-4.76), (p = 0.01), after disconnection, whereas deceleration time of E wave decreased from 185 ms (120-280) to 160 ms (70-206) (p = 0.02). Conclusion: During successful weaning from mechanical ventilation ANP levels increase in all patients whereas changes in BNP levels depend on underlying cardiac function. Changes in Doppler mitral flow indexes following ventilator disconnection suggest an increase in left-ventricular filling pressure.
Anesthesiology, May 1, 2005
Background: Lung deposition of intravenous cephalosporins is low. The lung deposition of equivale... more Background: Lung deposition of intravenous cephalosporins is low. The lung deposition of equivalent doses of ceftazidime administered either intravenously or by ultrasonic nebulization using either nitrogen-oxygen or helium-oxygen as the carrying gas of the aerosol was compared in ventilated piglets with and without experimental bronchopneumonia. Methods: Five piglets with noninfected lungs and 5 piglets with Pseudomonas aeruginosa experimental bronchopneumonia received 33 mg/kg ceftazidime intravenously. Ten piglets with noninfected lungs and 10 others with experimental P. aeruginosa bronchopneumonia received 50 mg/kg ceftazidime by ultrasonic nebulization. In each group, the ventilator was operated in half of the animals with a 65%/35% helium-oxygen or nitrogen-oxygen mixture. Animals were killed, and multiple lung specimens were sampled for measuring ceftazidime lung tissue concentrations by high-performance liquid chromatography. Results: As compared with intravenous administration, nebulization of ceftazidime significantly increased lung tissue concentrations (17 ؎ 13 vs. 383 ؎ 84 g/g in noninfected piglets and 10 ؎ 3 vs. 129 ؎ 108 g/g in piglets with experimental bronchopneumonia; P < 0.001). The use of a 65%/35% heliumoxygen mixture induced a 33% additional increase in lung tissue concentrations in noninfected piglets (576 ؎ 141 g/g; P < 0.001) and no significant change in infected piglets (111 ؎ 104 g/g). Conclusion: Nebulization of ceftazidime induced a 5-to 30fold increase in lung tissue concentrations as compared with intravenous administration. Using a helium-oxygen mixture as the carrying gas of the aerosol induced a substantial additional increase in lung deposition in noninfected piglets but not in piglets with experimental bronchopneumonia.
Mechanical ventilation and lung infection in the genesis of
Critical care (London, England), 2007
Air-space enlargement may result from mechanical ventilation and/or lung infection. The aim of th... more Air-space enlargement may result from mechanical ventilation and/or lung infection. The aim of this study was to assess how mechanical ventilation and lung infection influence the genesis of bronchiolar and alveolar distention. Four groups of piglets were studied: non-ventilated-non-inoculated (controls, n = 5), non-ventilated-inoculated (n = 6), ventilated-non-inoculated (n = 6), and ventilated-inoculated (n = 8) piglets. The respiratory tract of intubated piglets was inoculated with a highly concentrated solution of Escherichia coli. Mechanical ventilation was maintained during 60 hours with a tidal volume of 15 ml/kg and zero positive end-expiratory pressure. After sacrifice by exsanguination, lungs were fixed for histological and lung morphometry analyses. Lung infection was present in all inoculated piglets and in five of the six ventilated-non-inoculated piglets. Mean alveolar and mean bronchiolar areas, measured using an analyzer computer system connected through a high-resol...
The Lancet Infectious Diseases, 2001
Journal of Clinical Virology, 2007
Intensive Care Medicine, 2007
Objective: We examined whether invasive lung-specimen collection-to-treatment times for intensive... more Objective: We examined whether invasive lung-specimen collection-to-treatment times for intensive care unit patients with suspected ventilator-associated pneumonia (VAP) differ with to the work shift during which specimens were collected. We compared weekday day shifts and off-hours (from 6:30 p.m. to 8:29 a.m. the next day for night shifts, from Saturday 1:00 p.m. to Monday 8:29 a.m. for weekends, and from 8:30 a.m. to 8:29 a.m. the following morning for public holidays). Design and setting: Single-center, observational study in the intensive care unit in an academic teaching hospital. Patients and participants: 101 patients who developed 152 episodes of bacteriologically confirmed VAP. Measurements and results: Of the 152 VAP episodes 66 were diagnosed during off-hours. Neither more bronchoscopy complications nor more inappropriate initial antimicrobial treatments for patients were observed between day and off-hour shifts. Indeed, the overall time from brochoalveolar lavage to antibiotic administration was shorter for offhours than day-shifts due to shorter specimen collection-to-antibiotic prescription times, but antibiotic prescription-to-administration times were the same. Conclusions: An invasive strategy based on bronchoscopy to diagnose VAP was not associated with a longer time to first appropriate antibiotic administration when clinical suspicion of VAP occurs during off-hours.
Intensive Care Medicine, 2005
Objective: To document the prevalence of respiratory virus infections in patients with chronic ca... more Objective: To document the prevalence of respiratory virus infections in patients with chronic cardiac or pulmonary disorders admitted to a critical care unit for acute cardiorespiratory failure. Design, setting, patients: The study took place in a critical care unit during two consecutive winters. All patients admitted to the unit for acute respiratory or cardiac failure were enrolled. A nasal swab was taken for polymerase chain reaction (PCR) detection of influenza virus, respiratory syncytial virus (RSV), metapneumovirus, rhinovirus, and coronavirus. Results: One hundred twenty-two patients were enrolled. Their mean age was 69 years; 42% of the patients were female; the new simplified acute physiology score (SAPS II) score on admission was 35.6; 94% of patients had acute respiratory failure, 14% reported "influenza-like" illness before admission, and 11% of patients died in the unit. Twenty-one patients (17%) tested positive for a respiratory virus. The per-1,000 positivity rates were influenza virus 66, RSV 49, rhinovirus 33, metapneumovirus 16, and coronavirus 8. No link was found between virologic results and clinical outcome. A strong link was found between the rate of influenza virus positivity and the incidence of flulike illness in the community (p=0.017). Conclusion: These results show that respiratory virus infection-particularly influenza virus infection during epidemic periods-is common among patients hospitalized for acute cardiorespiratory failure.
Intensive Care Medicine, 2006
Objective: Lung tissue deposition of intravenous ceftazidime administered either continuously or ... more Objective: Lung tissue deposition of intravenous ceftazidime administered either continuously or intermittently was compared in ventilated piglets with experimental bronchopneumonia. Design: Prospective experimental study Animals: Eighteen anesthetized and ventilated piglets Interventions: Bronchopneumonia was produced by the intrabronchial inoculation of Pseudomonas aeruginosa characterized by an impaired sensitivity to ceftazidime (MIC 16 mg/l). Ceftazidime was administered either through a continuous infusion of 90 mg/kg per 24 h after a bolus of 30 mg/kg or by an intermittent infusion of 30 mg/kg per 8 h. Measurements and results: Piglets were killed 24 h after the initiation of continuous ceftazidime (n = 6), and 1 h (peak, n = 6) and 8 h (trough, n = 6) after the third dose following intermittent administration. Lung tissue concentrations of ceftazidime, measured by HPLC, and lung bacterial burden were assessed on multiple postmortem lung specimens. During continuous administration ceftazidime lung tissue concentrations were 9.7 ± 3.8 µg/g. Following intermittent administration peak and trough lung tissue concentrations were, respectively, 7.1 ± 2.4 µg/g and 0.6 ± 1 µg/g. Lung bacterial burden was different after continuous and intermittent administration (median 7.10 3 vs. 4.10 2 cfu/g). Conclusions: Continuous infusion of ceftazidime maintained higher tissue concentrations than intermittent administration.
Intensive Care Medicine, 2007
Objective: To assess the cardiac consequences of successful respiratory weaning using the variati... more Objective: To assess the cardiac consequences of successful respiratory weaning using the variations of circulating B-type and atrial natriuretic peptides (BNP, ANP) and Doppler mitral flow. Design: A prospective preliminary observational study. Setting: A 14-bed medical ICU in a French university hospital. Patients: Thirty-one patients undergoing a spontaneous breathing trial on a T-tube. Interventions: Circulating BNP and ANP levels and Doppler-derived E/A ratio and deceleration time of the E wave were measured before and 1 h after disconnection. Results: BNP levels increased from 299 pg/ml (range 56-1079) to 412 pg/ml (147-1324) (p = 0.02) in patients with systolic left ventricular dysfunction, decreased from 98 pg/ml (25-337) to 45 pg/ml (38-180) (p = 0.04) in patients with right ventricular dilation and remained unchanged in patients with neither of these cardiac abnormalities. Overall ANP levels increased from 33 pg/ml to 67 pg/ml (p < 0.001) regardless of ventricular function. The E/A ratio increased from 0.91 (0.66-3.56) to 1.17 (0.5-4.76), (p = 0.01), after disconnection, whereas deceleration time of E wave decreased from 185 ms (120-280) to 160 ms (70-206) (p = 0.02). Conclusion: During successful weaning from mechanical ventilation ANP levels increase in all patients whereas changes in BNP levels depend on underlying cardiac function. Changes in Doppler mitral flow indexes following ventilator disconnection suggest an increase in left-ventricular filling pressure.
Anesthesiology, 2005
Background Lung deposition of intravenous cephalosporins is low. The lung deposition of equivalen... more Background Lung deposition of intravenous cephalosporins is low. The lung deposition of equivalent doses of ceftazidime administered either intravenously or by ultrasonic nebulization using either nitrogen-oxygen or helium-oxygen as the carrying gas of the aerosol was compared in ventilated piglets with and without experimental bronchopneumonia. Methods Five piglets with noninfected lungs and 5 piglets with Pseudomonas aeruginosa experimental bronchopneumonia received 33 mg/kg ceftazidime intravenously. Ten piglets with noninfected lungs and 10 others with experimental P. aeruginosa bronchopneumonia received 50 mg/kg ceftazidime by ultrasonic nebulization. In each group, the ventilator was operated in half of the animals with a 65%/35% helium-oxygen or nitrogen-oxygen mixture. Animals were killed, and multiple lung specimens were sampled for measuring ceftazidime lung tissue concentrations by high-performance liquid chromatography. Results As compared with intravenous administration...
Intensive Care Medicine, 2008
Objective: To assess the predictive capacity for the diagnosis of ventilator-associated pneumonia... more Objective: To assess the predictive capacity for the diagnosis of ventilator-associated pneumonia (VAP) of serum procalcitonin levels before and on the day it is suspected. Design and setting: Single-center observational study in the intensive care unit of a teaching hospital. Patients and participants: Consecutive patients whose serum procalcitonin levels were available on the day that VAP was clinically suspected (day 1) and at some time within the preceding 5 days ("before"). Measurements and results: Serum procalcitonin levels were determined on day 1 and "before". Among the 73 suspected episodes VAP was confirmed by quantitative bronchoalveolar lavage cultures in 32 and refuted in 41. Respective median "before" pro-calcitonin levels were 1.89 ng/ml (interquartile range 0.18-6.01) and 2.14 (0.76-5.75) in patients with and without VAP, but their respective median day-1 procalcitonin levels did not differ: 1.07 ng/ml (0.39-6.57) vs. 1.40 (0.67-3.39). On day 1 a 0.5 ng/ml procalcitonin threshold had 72% sensitivity but only 24% specificity for diagnosing VAP. Between "before" and day 1, procalcitonin increased in 41% and 15% of patients with and without VAP, respectively. Thus a procalcitonin rise on day 1, compared to its "before" level, had 41% sensitivity and 85% specificity for diagnosing VAP, with respective positive and negative predictive values of 68% and 65%. Conclusions: Crude values and procalcitonin rise had poor diagnostic value for VAP in this particular setting and thus should not be used to initiate antibiotics when VAP is clinically suspected.
Intensive Care Medicine, Nov 19, 2005
Objective: To document the prevalence of respiratory virus infections in patients with chronic ca... more Objective: To document the prevalence of respiratory virus infections in patients with chronic cardiac or pulmonary disorders admitted to a critical care unit for acute cardiorespiratory failure. Design, setting, patients: The study took place in a critical care unit during two consecutive winters. All patients admitted to the unit for acute respiratory or cardiac failure were enrolled. A nasal swab was taken for polymerase chain reaction (PCR) detection of influenza virus, respiratory syncytial virus (RSV), metapneumovirus, rhinovirus, and coronavirus. Results: One hundred twenty-two patients were enrolled. Their mean age was 69 years; 42% of the patients were female; the new simplified acute physiology score (SAPS II) score on admission was 35.6; 94% of patients had acute respiratory failure, 14% reported "influenza-like" illness before admission, and 11% of patients died in the unit. Twenty-one patients (17%) tested positive for a respiratory virus. The per-1,000 positivity rates were influenza virus 66, RSV 49, rhinovirus 33, metapneumovirus 16, and coronavirus 8. No link was found between virologic results and clinical outcome. A strong link was found between the rate of influenza virus positivity and the incidence of flulike illness in the community (p=0.017). Conclusion: These results show that respiratory virus infection-particularly influenza virus infection during epidemic periods-is common among patients hospitalized for acute cardiorespiratory failure.
PubMed, Jun 8, 2002
Introduction: Enterococci are frequently responsible for endocarditis, but a rare cause of mening... more Introduction: Enterococci are frequently responsible for endocarditis, but a rare cause of meningitis. Observation: A 55 years-old man presented with Enterococcus faecium meningitis. Systematic transoesophageal echocardiography (TOE), despite the absence of organic murmur and the negativity of the hemocultures, revealed a concomitant aortic endocarditis. Conclusion: Review of the literature suggests that the association of endocarditis with enterococcal meningitis is far from accidental. We suggest that a TOS be conducted systematically when faced with this disease. The therapeutic implications are important, notably regarding the duration of antibiotherapy.
Intensive Care Medicine, Jul 21, 2006
Objective: Lung tissue deposition of intravenous ceftazidime administered either continuously or ... more Objective: Lung tissue deposition of intravenous ceftazidime administered either continuously or intermittently was compared in ventilated piglets with experimental bronchopneumonia. Design: Prospective experimental study Animals: Eighteen anesthetized and ventilated piglets Interventions: Bronchopneumonia was produced by the intrabronchial inoculation of Pseudomonas aeruginosa characterized by an impaired sensitivity to ceftazidime (MIC 16 mg/l). Ceftazidime was administered either through a continuous infusion of 90 mg/kg per 24 h after a bolus of 30 mg/kg or by an intermittent infusion of 30 mg/kg per 8 h. Measurements and results: Piglets were killed 24 h after the initiation of continuous ceftazidime (n = 6), and 1 h (peak, n = 6) and 8 h (trough, n = 6) after the third dose following intermittent administration. Lung tissue concentrations of ceftazidime, measured by HPLC, and lung bacterial burden were assessed on multiple postmortem lung specimens. During continuous administration ceftazidime lung tissue concentrations were 9.7 ± 3.8 µg/g. Following intermittent administration peak and trough lung tissue concentrations were, respectively, 7.1 ± 2.4 µg/g and 0.6 ± 1 µg/g. Lung bacterial burden was different after continuous and intermittent administration (median 7.10 3 vs. 4.10 2 cfu/g). Conclusions: Continuous infusion of ceftazidime maintained higher tissue concentrations than intermittent administration.
Intensive Care Medicine, Apr 3, 2007
Objective: To assess the cardiac consequences of successful respiratory weaning using the variati... more Objective: To assess the cardiac consequences of successful respiratory weaning using the variations of circulating B-type and atrial natriuretic peptides (BNP, ANP) and Doppler mitral flow. Design: A prospective preliminary observational study. Setting: A 14-bed medical ICU in a French university hospital. Patients: Thirty-one patients undergoing a spontaneous breathing trial on a T-tube. Interventions: Circulating BNP and ANP levels and Doppler-derived E/A ratio and deceleration time of the E wave were measured before and 1 h after disconnection. Results: BNP levels increased from 299 pg/ml (range 56-1079) to 412 pg/ml (147-1324) (p = 0.02) in patients with systolic left ventricular dysfunction, decreased from 98 pg/ml (25-337) to 45 pg/ml (38-180) (p = 0.04) in patients with right ventricular dilation and remained unchanged in patients with neither of these cardiac abnormalities. Overall ANP levels increased from 33 pg/ml to 67 pg/ml (p < 0.001) regardless of ventricular function. The E/A ratio increased from 0.91 (0.66-3.56) to 1.17 (0.5-4.76), (p = 0.01), after disconnection, whereas deceleration time of E wave decreased from 185 ms (120-280) to 160 ms (70-206) (p = 0.02). Conclusion: During successful weaning from mechanical ventilation ANP levels increase in all patients whereas changes in BNP levels depend on underlying cardiac function. Changes in Doppler mitral flow indexes following ventilator disconnection suggest an increase in left-ventricular filling pressure.
Anesthesiology, May 1, 2005
Background: Lung deposition of intravenous cephalosporins is low. The lung deposition of equivale... more Background: Lung deposition of intravenous cephalosporins is low. The lung deposition of equivalent doses of ceftazidime administered either intravenously or by ultrasonic nebulization using either nitrogen-oxygen or helium-oxygen as the carrying gas of the aerosol was compared in ventilated piglets with and without experimental bronchopneumonia. Methods: Five piglets with noninfected lungs and 5 piglets with Pseudomonas aeruginosa experimental bronchopneumonia received 33 mg/kg ceftazidime intravenously. Ten piglets with noninfected lungs and 10 others with experimental P. aeruginosa bronchopneumonia received 50 mg/kg ceftazidime by ultrasonic nebulization. In each group, the ventilator was operated in half of the animals with a 65%/35% helium-oxygen or nitrogen-oxygen mixture. Animals were killed, and multiple lung specimens were sampled for measuring ceftazidime lung tissue concentrations by high-performance liquid chromatography. Results: As compared with intravenous administration, nebulization of ceftazidime significantly increased lung tissue concentrations (17 ؎ 13 vs. 383 ؎ 84 g/g in noninfected piglets and 10 ؎ 3 vs. 129 ؎ 108 g/g in piglets with experimental bronchopneumonia; P < 0.001). The use of a 65%/35% heliumoxygen mixture induced a 33% additional increase in lung tissue concentrations in noninfected piglets (576 ؎ 141 g/g; P < 0.001) and no significant change in infected piglets (111 ؎ 104 g/g). Conclusion: Nebulization of ceftazidime induced a 5-to 30fold increase in lung tissue concentrations as compared with intravenous administration. Using a helium-oxygen mixture as the carrying gas of the aerosol induced a substantial additional increase in lung deposition in noninfected piglets but not in piglets with experimental bronchopneumonia.
Mechanical ventilation and lung infection in the genesis of
Critical care (London, England), 2007
Air-space enlargement may result from mechanical ventilation and/or lung infection. The aim of th... more Air-space enlargement may result from mechanical ventilation and/or lung infection. The aim of this study was to assess how mechanical ventilation and lung infection influence the genesis of bronchiolar and alveolar distention. Four groups of piglets were studied: non-ventilated-non-inoculated (controls, n = 5), non-ventilated-inoculated (n = 6), ventilated-non-inoculated (n = 6), and ventilated-inoculated (n = 8) piglets. The respiratory tract of intubated piglets was inoculated with a highly concentrated solution of Escherichia coli. Mechanical ventilation was maintained during 60 hours with a tidal volume of 15 ml/kg and zero positive end-expiratory pressure. After sacrifice by exsanguination, lungs were fixed for histological and lung morphometry analyses. Lung infection was present in all inoculated piglets and in five of the six ventilated-non-inoculated piglets. Mean alveolar and mean bronchiolar areas, measured using an analyzer computer system connected through a high-resol...
The Lancet Infectious Diseases, 2001
Journal of Clinical Virology, 2007
Intensive Care Medicine, 2007
Objective: We examined whether invasive lung-specimen collection-to-treatment times for intensive... more Objective: We examined whether invasive lung-specimen collection-to-treatment times for intensive care unit patients with suspected ventilator-associated pneumonia (VAP) differ with to the work shift during which specimens were collected. We compared weekday day shifts and off-hours (from 6:30 p.m. to 8:29 a.m. the next day for night shifts, from Saturday 1:00 p.m. to Monday 8:29 a.m. for weekends, and from 8:30 a.m. to 8:29 a.m. the following morning for public holidays). Design and setting: Single-center, observational study in the intensive care unit in an academic teaching hospital. Patients and participants: 101 patients who developed 152 episodes of bacteriologically confirmed VAP. Measurements and results: Of the 152 VAP episodes 66 were diagnosed during off-hours. Neither more bronchoscopy complications nor more inappropriate initial antimicrobial treatments for patients were observed between day and off-hour shifts. Indeed, the overall time from brochoalveolar lavage to antibiotic administration was shorter for offhours than day-shifts due to shorter specimen collection-to-antibiotic prescription times, but antibiotic prescription-to-administration times were the same. Conclusions: An invasive strategy based on bronchoscopy to diagnose VAP was not associated with a longer time to first appropriate antibiotic administration when clinical suspicion of VAP occurs during off-hours.
Intensive Care Medicine, 2005
Objective: To document the prevalence of respiratory virus infections in patients with chronic ca... more Objective: To document the prevalence of respiratory virus infections in patients with chronic cardiac or pulmonary disorders admitted to a critical care unit for acute cardiorespiratory failure. Design, setting, patients: The study took place in a critical care unit during two consecutive winters. All patients admitted to the unit for acute respiratory or cardiac failure were enrolled. A nasal swab was taken for polymerase chain reaction (PCR) detection of influenza virus, respiratory syncytial virus (RSV), metapneumovirus, rhinovirus, and coronavirus. Results: One hundred twenty-two patients were enrolled. Their mean age was 69 years; 42% of the patients were female; the new simplified acute physiology score (SAPS II) score on admission was 35.6; 94% of patients had acute respiratory failure, 14% reported "influenza-like" illness before admission, and 11% of patients died in the unit. Twenty-one patients (17%) tested positive for a respiratory virus. The per-1,000 positivity rates were influenza virus 66, RSV 49, rhinovirus 33, metapneumovirus 16, and coronavirus 8. No link was found between virologic results and clinical outcome. A strong link was found between the rate of influenza virus positivity and the incidence of flulike illness in the community (p=0.017). Conclusion: These results show that respiratory virus infection-particularly influenza virus infection during epidemic periods-is common among patients hospitalized for acute cardiorespiratory failure.
Intensive Care Medicine, 2006
Objective: Lung tissue deposition of intravenous ceftazidime administered either continuously or ... more Objective: Lung tissue deposition of intravenous ceftazidime administered either continuously or intermittently was compared in ventilated piglets with experimental bronchopneumonia. Design: Prospective experimental study Animals: Eighteen anesthetized and ventilated piglets Interventions: Bronchopneumonia was produced by the intrabronchial inoculation of Pseudomonas aeruginosa characterized by an impaired sensitivity to ceftazidime (MIC 16 mg/l). Ceftazidime was administered either through a continuous infusion of 90 mg/kg per 24 h after a bolus of 30 mg/kg or by an intermittent infusion of 30 mg/kg per 8 h. Measurements and results: Piglets were killed 24 h after the initiation of continuous ceftazidime (n = 6), and 1 h (peak, n = 6) and 8 h (trough, n = 6) after the third dose following intermittent administration. Lung tissue concentrations of ceftazidime, measured by HPLC, and lung bacterial burden were assessed on multiple postmortem lung specimens. During continuous administration ceftazidime lung tissue concentrations were 9.7 ± 3.8 µg/g. Following intermittent administration peak and trough lung tissue concentrations were, respectively, 7.1 ± 2.4 µg/g and 0.6 ± 1 µg/g. Lung bacterial burden was different after continuous and intermittent administration (median 7.10 3 vs. 4.10 2 cfu/g). Conclusions: Continuous infusion of ceftazidime maintained higher tissue concentrations than intermittent administration.
Intensive Care Medicine, 2007
Objective: To assess the cardiac consequences of successful respiratory weaning using the variati... more Objective: To assess the cardiac consequences of successful respiratory weaning using the variations of circulating B-type and atrial natriuretic peptides (BNP, ANP) and Doppler mitral flow. Design: A prospective preliminary observational study. Setting: A 14-bed medical ICU in a French university hospital. Patients: Thirty-one patients undergoing a spontaneous breathing trial on a T-tube. Interventions: Circulating BNP and ANP levels and Doppler-derived E/A ratio and deceleration time of the E wave were measured before and 1 h after disconnection. Results: BNP levels increased from 299 pg/ml (range 56-1079) to 412 pg/ml (147-1324) (p = 0.02) in patients with systolic left ventricular dysfunction, decreased from 98 pg/ml (25-337) to 45 pg/ml (38-180) (p = 0.04) in patients with right ventricular dilation and remained unchanged in patients with neither of these cardiac abnormalities. Overall ANP levels increased from 33 pg/ml to 67 pg/ml (p < 0.001) regardless of ventricular function. The E/A ratio increased from 0.91 (0.66-3.56) to 1.17 (0.5-4.76), (p = 0.01), after disconnection, whereas deceleration time of E wave decreased from 185 ms (120-280) to 160 ms (70-206) (p = 0.02). Conclusion: During successful weaning from mechanical ventilation ANP levels increase in all patients whereas changes in BNP levels depend on underlying cardiac function. Changes in Doppler mitral flow indexes following ventilator disconnection suggest an increase in left-ventricular filling pressure.
Anesthesiology, 2005
Background Lung deposition of intravenous cephalosporins is low. The lung deposition of equivalen... more Background Lung deposition of intravenous cephalosporins is low. The lung deposition of equivalent doses of ceftazidime administered either intravenously or by ultrasonic nebulization using either nitrogen-oxygen or helium-oxygen as the carrying gas of the aerosol was compared in ventilated piglets with and without experimental bronchopneumonia. Methods Five piglets with noninfected lungs and 5 piglets with Pseudomonas aeruginosa experimental bronchopneumonia received 33 mg/kg ceftazidime intravenously. Ten piglets with noninfected lungs and 10 others with experimental P. aeruginosa bronchopneumonia received 50 mg/kg ceftazidime by ultrasonic nebulization. In each group, the ventilator was operated in half of the animals with a 65%/35% helium-oxygen or nitrogen-oxygen mixture. Animals were killed, and multiple lung specimens were sampled for measuring ceftazidime lung tissue concentrations by high-performance liquid chromatography. Results As compared with intravenous administration...
Intensive Care Medicine, 2008
Objective: To assess the predictive capacity for the diagnosis of ventilator-associated pneumonia... more Objective: To assess the predictive capacity for the diagnosis of ventilator-associated pneumonia (VAP) of serum procalcitonin levels before and on the day it is suspected. Design and setting: Single-center observational study in the intensive care unit of a teaching hospital. Patients and participants: Consecutive patients whose serum procalcitonin levels were available on the day that VAP was clinically suspected (day 1) and at some time within the preceding 5 days ("before"). Measurements and results: Serum procalcitonin levels were determined on day 1 and "before". Among the 73 suspected episodes VAP was confirmed by quantitative bronchoalveolar lavage cultures in 32 and refuted in 41. Respective median "before" pro-calcitonin levels were 1.89 ng/ml (interquartile range 0.18-6.01) and 2.14 (0.76-5.75) in patients with and without VAP, but their respective median day-1 procalcitonin levels did not differ: 1.07 ng/ml (0.39-6.57) vs. 1.40 (0.67-3.39). On day 1 a 0.5 ng/ml procalcitonin threshold had 72% sensitivity but only 24% specificity for diagnosing VAP. Between "before" and day 1, procalcitonin increased in 41% and 15% of patients with and without VAP, respectively. Thus a procalcitonin rise on day 1, compared to its "before" level, had 41% sensitivity and 85% specificity for diagnosing VAP, with respective positive and negative predictive values of 68% and 65%. Conclusions: Crude values and procalcitonin rise had poor diagnostic value for VAP in this particular setting and thus should not be used to initiate antibiotics when VAP is clinically suspected.