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Papers by Olivier Barbot

Research paper thumbnail of Overview of the current use of levosimendan in France: a prospective observational cohort study

Annals of Intensive Care

Background Following the results of randomized controlled trials on levosimendan, French health a... more Background Following the results of randomized controlled trials on levosimendan, French health authorities requested an update of the current use and side-effects of this medication on a national scale. Method The France-LEVO registry was a prospective observational cohort study reflecting the indications, dosing regimens, and side-effects of levosimendan, as well as patient outcomes over a year. Results The patients included (n = 602) represented 29.6% of the national yearly use of levosimendan in France. They were treated for cardiogenic shock (n = 250, 41.5%), decompensated heart failure (n = 127, 21.1%), cardiac surgery-related low cardiac output prophylaxis and/or treatment (n = 86, 14.3%), and weaning from veno-arterial extracorporeal membrane oxygenation (n = 82, 13.6%). They received 0.18 ± 0.07 µg/kg/min levosimendan over 26 ± 8 h. An initial bolus was administered in 45 patients (7.5%), 103 (17.1%) received repeated infusions, and 461 (76.6%) received inotropes and or vas...

Research paper thumbnail of Admission High-Sensitive Cardiac Troponin T Level Increase Is Independently Associated with Higher Mortality in Critically Ill Patients with COVID-19: A Multicenter Study

Journal of Clinical Medicine, 2021

Background: In coronavirus disease 2019 (COVID-19) patients, increases in high-sensitive cardiac ... more Background: In coronavirus disease 2019 (COVID-19) patients, increases in high-sensitive cardiac troponin T (hs-cTnT) have been reported to be associated with worse outcomes. In the critically ill, the prognostic value of hs-cTnT, however, remains to be assessed given that most previous studies have involved a case mix of non- and severely ill COVID-19 patients. Methods: We conducted, from March to May 2020, in three French intensive care units (ICUs), a multicenter retrospective cohort study to assess in-hospital mortality predictability of hs-cTnT levels in COVID-19 patients. Results: 111 laboratory-confirmed COVID-19 patients (68% of male, median age 67 (58–75) years old) were included. At ICU admission, the median Charlson Index, Simplified Acute Physiology Score II, and PaO2/FiO2 were at 3 (2–5), 37 (27–48), and 140 (98–154), respectively, and the median hs-cTnT serum levels were at 16.0 (10.1–31.9) ng/L. Seventy-five patients (68%) were mechanically ventilated, 41 (37%) were t...

Research paper thumbnail of French Intensive Care Society, International congress – Réanimation 2016

Annals of Intensive Care, 2016

Research paper thumbnail of SeverePlasmodium malariaeMalaria in a Patient With Multiple Susceptibility Genes

Journal of Travel Medicine, May 1, 2010

Research paper thumbnail of ResearchRecommendations for the intra-hospital transport of critically ill patients

Introduction: This study was conducted to provide Intensive Care Units and Emergency Departments ... more Introduction: This study was conducted to provide Intensive Care Units and Emergency Departments with a set of practical procedures (check-lists) for managing critically-ill adult patients in order to avoid complications during intrahospital transport (IHT). Methods: Digital research was carried out via the MEDLINE, EMBASE, CINAHL and HEALTHSTAR databases using the following key words: transferring, transport, intrahospital or intra-hospital, and critically ill patient. The reference bibliographies of each of the selected articles between 1998 and 2009 were also studied. Results: This review focuses on the analysis and overcoming of IHT-related risks, the associated adverse events, and their nature and incidence. The suggested preventive measures are also reviewed. A check-list for quick execution of IHT is then put forward and justified. Conclusions: Despite improvements in IHT practices, significant risks are still involved. Basic training, good clinical sense and a risk-benefit a...

Research paper thumbnail of Recommendations for the intra-hospital transport of critically ill patients

Critical Care, 2010

Introduction: This study was conducted to provide Intensive Care Units and Emergency Departments ... more Introduction: This study was conducted to provide Intensive Care Units and Emergency Departments with a set of practical procedures (check-lists) for managing critically-ill adult patients in order to avoid complications during intrahospital transport (IHT). Methods: Digital research was carried out via the MEDLINE, EMBASE, CINAHL and HEALTHSTAR databases using the following key words: transferring, transport, intrahospital or intra-hospital, and critically ill patient. The reference bibliographies of each of the selected articles between 1998 and 2009 were also studied. Results: This review focuses on the analysis and overcoming of IHT-related risks, the associated adverse events, and their nature and incidence. The suggested preventive measures are also reviewed. A checklist for quick execution of IHT is then put forward and justified. Conclusions: Despite improvements in IHT practices, significant risks are still involved. Basic training, good clinical sense and a risk-benefit analysis are currently the only deciding factors. A critically ill patient, prepared and accompanied by an inexperienced team, is a risky combination. The development of adapted equipment and the widespread use of checklists and proper training programmes would increase the safety of IHT and reduce the risks in the long-term. Further investigation is required in order to evaluate the protective role of such preventive measures.

Research paper thumbnail of Épuration de CO2 chez les patients ayant une défaillance rénale et respiratoire à l’aide d’une machine d’épuration extra-rénale classique

Annales Françaises d'Anesthésie et de Réanimation, 2013

Research paper thumbnail of Outcome of patients treated with molecular adsorbent recirculating system albumin dialysis: A national multicenter study

JGH Open, 2020

Background and Aim: The molecular adsorbent recirculating system (MARS) is the most widely used d... more Background and Aim: The molecular adsorbent recirculating system (MARS) is the most widely used device to treat liver failure. Nevertheless, data from widespread real-life use are lacking. Methods: This was a retrospective multicenter study conducted in all French adult care centers that used MARS between 2004 and 2009. The primary objective was to evaluate patient survival according to the liver disease and listing status. Factors associated with mortality were the secondary objectives. Results: A total of 383 patients underwent 393 MARS treatments. The main indications were acute liver failure (ALF, 32.6%), and severe cholestasis (total bilirubin >340 μmol/L) (37.2%), hepatic encephalopathy (23.7%), and/or acute kidney injuryhepatorenal syndrome (22.9%) most often among patients with chronic liver disease. At the time of treatment, 34.4% of the patients were listed. Overall, the hospital survival rate was 49% (95% CI: 44-54%) and ranged from 25% to 81% depending on the diagnosis of the liver disease. In listed patients versus those not listed, the 1-year survival rate was markedly better in the setting of nonbiliary cirrhosis (59% vs 15%), early graft nonfunction (80% vs 0%), and late graft dysfunction (72% vs 0%) (all P < 0.001). Among nonbiliary cirrhotic patients, hospital mortality was associated with the severity of liver disease (HE and severe cholestasis) and not being listed for transplant. In ALF, paracetamol etiology and ≥3 MARS sessions were associated with better transplant-free survival. Conclusion: Our study suggests that MARS should be mainly used as a bridge to liver transplantation. Survival was correlated with being listed for most etiologies and with the intensity of treatment in ALF.

Research paper thumbnail of Plasma citrulline kinetics and prognostic value in critically ill patients

European Journal of Intensive Care Medicine, Jan 19, 2010

There is considerable uncertainty about the reproducibility of the various instruments used to me... more There is considerable uncertainty about the reproducibility of the various instruments used to measure dyspnea, their ability to reflect changes in symptoms, whether they accurately reflect the patient's experience and if its evolution is similar between acute heart failure syndrome patients and nonacute heart failure syndrome patients. URGENT was a prospective multicenter trial designed to address these issues. Methods Patients were interviewed within 1 hour of first physician evaluation, in the emergency department or acute care setting, with dyspnea assessed by the patient using both a five-point Likert scale and a 10-point visual analog scale (VAS) in the sitting (60º) and then supine (20º) position if dyspnea had not been considered severe or very severe by the sitting versus decubitus dyspnea measurement. Results Very good agreements were found between the five-point Likert and VAS at baseline (0.891, P <0.0001) and between changes (from baseline to hour 6) in the five-point Likert and in VAS (0.800, P <0.0001) in acute heart failure (AHF) patients. Lower agreements were found when changes from baseline to H6 measured by Likert or VAS were compared with the seven-point comparative Likert (0.512 and 0.500 respectively) in AHF patients. The worse the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours; this relationship is stronger when dyspnea is measured with VAS (Spearman's rho coefficient = 0.672) than with the five-point Likert (0.272) (both P <0.0001) in AHF patients. By the five-point Likert, only nine patients (3% (1% to 5%)) reported an improvement in their dyspnea, 177 (51% (46% to 57%)) had no change, and 159 (46% (41% to 52%)) reported worse dyspnea supine compared with sitting up in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Conclusions Both clinical tools five-point Likert and VAS showed very good agreement at baseline and between changes from baseline to tests performed 6 hours later in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Dyspnea is improved within 6 hours in more than threequarters of the patients regardless of the tool used to measure the change in dyspnea. The greater the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours.

Research paper thumbnail of partial EC CO2 removal - 2014

To test the feasibility, safety, and efficacy of partial extracorporeal CO 2 removal (PECCO 2 R) ... more To test the feasibility, safety, and efficacy of partial extracorporeal CO 2 removal (PECCO 2 R) using a standard continuous renal replacement (CRRT) device with a pediatric oxygenation membrane introduced into the circuit in a serial manner. In this retrospective single-center study, we have studied mechanically ventilated patients with persistent significant respiratory acidosis and acute renal failure requiring ongoing CRRT. Sixteen patients were treated with our PECCO 2 R device. PaCO 2 and arterial pH were measured before as well as at 6 and 12 hours after PECCO 2 R implementation. Hemodynamic parameters were continuously monitored. Our PEC-CO 2 R system was efficient to significantly reduce PaCO 2 and increase arterial pH. The median PaCO 2 before treatment was 77 mm Hg (59-112) with a median reduction of 24 mm Hg after 6 hours and 30 mm Hg after 12 hours (31% and 39%, respectively). The median pH increase was 0.16 at 6 hours and 0.23 at 12 hours. Partial extracorporeal CO 2 removal treatment had no effect on oxygenation. No complication was observed. Our PECCO 2 R approach based on the simple introduction of a pediatric extracorporeal membrane oxygenation membrane into the circuit of a standard CRRT device is easy to implement, safe, and efficient to improve respiratory acidosis. ASAIO Journal 2014; XX:00-00.

Research paper thumbnail of Capillary lactate as a tool for the triage nurse among patients with SIRS at emergency department presentation: a preliminary report

Annals of intensive care, 2015

The triage nurse is involved in the early identification of the most severe patients at emergency... more The triage nurse is involved in the early identification of the most severe patients at emergency department (ED) presentation. However, clinical criteria alone may be insufficient to identify them correctly. Measurement of capillary lactate concentration at ED presentation may help to discriminate these patients. The primary objective of this study was to identify the prognostic value of capillary lactate concentration measured by the triage nurse among patients presenting to the ED. This was a prospective observational study, performed in the ED of a university hospital. At ED presentation, capillary lactate measurement was performed by the triage nurse among patients presenting with a clinical criteria of systemic inflammatory response syndrome (SIRS). Clinical variables usually used to determine severity were collected at presentation. Twenty-eight-day mortality and MEDS score were recorded. One hundred seventy-six patients with clinical SIRS presented to the ED. Median age was ...

Research paper thumbnail of Partial Extracorporeal Carbon Dioxide Removal Using a Standard Continuous Renal Replacement Therapy Device

Research paper thumbnail of Acute ischemic pancreatitis following cardiac arrest: a case report

JOP : Journal of the pancreas, 2010

Ischemia is an established cause of acute pancreatitis; however, acute pancreatitis has never bee... more Ischemia is an established cause of acute pancreatitis; however, acute pancreatitis has never been reported after cardiac arrest. We report a case of acute pancreatitis following cardiac arrest with prolonged cardiopulmonary resuscitation in a 58-year-old man, the mechanism of which is likely to be ischemic. The patient developed severe ischemic encephalopathy, leading to death. Possible causes of acute pancreatitis in a context of cardiopulmonary resuscitation are discussed. In case of abdominal distension following cardiac arrest, diagnoses of mesenteric ischemia and acute ischemic pancreatitis should be considered. Such digestive complications occurring after cardiac arrest probably reflect the severity of the ischemia.

Research paper thumbnail of Circulations extracorporelles d’assistance respiratoire en réanimation chez l’adulte

Réanimation, 2009

ABSTRACT Since its first description, the care of the acute respiratory distress syndrome has con... more ABSTRACT Since its first description, the care of the acute respiratory distress syndrome has considerably changed. While pathophysiology remain a subject to debate and intensive research, the use of high tidal volume and airway pressure has been demonstrated to be harmful. Extracorporeal membrane oxygenation (ECMO) technics are able to remove carbon dioxide allowing gentle ventilation. According to the technic used, oxygenation and hemodynamic stability may be achieved. Several case reports have been published in the past and recent literature, however two prospective randomised trials failed to demonstrate an impact on survival rate. Heavily discussed on technics, experience and management of the teams involved in these study and according to new developments and concepts, several studies are waiting publication or under way. Extracorporeal membrane oxygenation is indicated as part of global strategy with dedicated and trained team to avoid complications and after referral if necessary.

Research paper thumbnail of Severe Plasmodium malariae Malaria in a Patient With Multiple Susceptibility Genes

Journal of Travel Medicine, 2010

We present a case of severe malaria due to Plasmodium malariae. Genetic testing showed that the p... more We present a case of severe malaria due to Plasmodium malariae. Genetic testing showed that the patient was homozygous for five important gene polymorphisms previously shown to be associated with increased susceptibility to, and/or severity of, severe sepsis. Our case suggests that P. malariae may cause life-threatening disease, and that disease severity may be linked, at least in part, to multiple susceptibility genes.

Research paper thumbnail of 274 THE CRP LEVEL IS A GOOD PREDICTOR OF MORTALITY INDEPENDENT OF PUGH OR MELD SCORES IN PATIENTS WITH END STAGE LIVER DISEASE (ESLD)

Journal of Hepatology, 2008

Bleeding from esophageal varices is a serious complication of portal hypertension, which still ca... more Bleeding from esophageal varices is a serious complication of portal hypertension, which still carries significant mortality. After control of the initial hemorrhage, early rebleeding remains a risk. Whether measures assessing liver disease severity and calculated fibrosis scores can assist in predicting outcome in patients with acute variceal bleeding is investigated in this study. Methods: Acute variceal bleeding was managed endoscopically in 965 patients (761 males, 204 females, mean age 52.6 years). All patients received antibiotic prophylaxis, and were followed for the occurrence of early rebleeding for 5 days if bleeding was controlled or till discharge. Patients had their Child score, MELD score, AST/ALT ratio, age-platelet index, APRI index, Phol's score, cirrhosis discriminant score (CDS) and Göteborg University cirrhosis index (GUCI) calculated on admission, and correlated to the outcome of initial bleeding and rebleeding if bleeding was controlled. Results: Mortality increased with increasing Child score: (0%, 2.4%, and 28% in Child A, B, and C, p < 0.001)) and MELD score (1.1%, 3.7%, 10%, and 48% in MELD 11; 12−15; 16−19; and 20 p < 0.001)). A cutoff of 20 for MELD had a sensitivity of 81.5% and specificity of 80.7% for predicting mortality and a cutoff of 10 for Child score had 80% sensitivity and 81.4% specificity. MELD and Child scores and the presence of encephalopathy had the highest power for predicting outcome (AUC = 0.889, 0.891, 0.886 respectively p < 0.001). AST/ALT ratio, ageplatelet index, APRI index, Phol's score, CDS and GUCI scores had lower discriminative power than MELD and CTP scores. Similarly, rebleeding increased with increasing Child and MELD scores. A shorter time between admission and endoscopy was a significant factor determining better survival and less rebleeding in patients with high Child and Meld scores. Conclusion: Increasing MELD and CTP scores and the presence of encephalopathy are associated with high mortality in acute variceal bleeding and can be used as predictors of outcome. Other indices of fibrosis have significantly less discriminant value and have no role in predicting outcome. Urgent endoscopy remains a very important therapeutic intervention and should be offered earlier with patients with higher scores.

Research paper thumbnail of C-Reactive protein predicts short-term mortality in patients with cirrhosis

Journal of Hepatology, 2012

Background & Aims: We aimed at improving prediction of shortterm mortality in cirrhotic inpatient... more Background & Aims: We aimed at improving prediction of shortterm mortality in cirrhotic inpatients by evaluating C-reactive protein (CRP) as a surrogate marker of systemic inflammatory response syndrome (SIRS). Methods: One-hundred and forty-eight consecutive cirrhotic patients with Child-Pugh score PB8 and without hepatocellular carcinoma were prospectively included and followed for 182 days. The primary end point was 6-month survival. Results: Main baseline characteristics were as follows: alcoholic liver disease in 88.5%; bacterial infection in 37%; hepatorenal syndrome in 7% of cases. CRP range was 1-240 mg/L (median 26 mg/L); 42 patients (28.4%) had SIRS as defined by ACCP/ SCCM-criteria. CRP levels were higher in patients with SIRS (50 vs. 21 mg/L; p <0.0001), infection (46 vs. 27 mg/L; p <0.0001), and alcoholic hepatitis (44 vs. 32 mg/L, p = 0.049). Forty-two patients died within the first 6 months of follow-up. Short-term mortality was associated with extrahepatic co-morbidities (p = 0.002), high MELD score (p <0.001; AUROC = 0.67), renal failure (p = 0.008), elevated blood lactates (p <0.001), and high baseline CRP levels (p = 0.003; AUROC = 0.63; best cut-off value at 29 mg/L). Among patients with baseline CRP P29 mg/L, 32 still had CRP P29 mg/L at day 15 (group A). Group A was associated with 6-month mortality in the overall population (p <0.001) and also through sentitivity analyses restricted to patients without infection or alcoholic hepatitis. Multivariate analysis (Cox) adjusted for age identified three predictors of mortality: high MELD score (HR = 1.08; 95% CI: 1.03-1.12; p <0.001), extrahepatic co-morbidities (HR = 2.51; 95% CI: 1.31-4.84; p = 0.006), and CRP level (group A) (HR = 2.73; 95% CI: 1.41-5.26; p = 0.003). The performance of the three variables taken together for predicting death was 0.80 (AUROC). Conclusions: In Child-Pugh score PB8 cirrhotic patients, persistent CRP levels P29 mg/L predicted short-term mortality independently of age, MELD, and co-morbidities, and better than infection or clinically-assessed SIRS. Ó

Research paper thumbnail of Plasma citrulline kinetics and prognostic value in critically ill patients

Intensive Care Medicine, 2010

Research paper thumbnail of Plasma citrulline kinetics and prognostic value in the critically ill patient

Critical Care, 2009

There is considerable uncertainty about the reproducibility of the various instruments used to me... more There is considerable uncertainty about the reproducibility of the various instruments used to measure dyspnea, their ability to reflect changes in symptoms, whether they accurately reflect the patient's experience and if its evolution is similar between acute heart failure syndrome patients and nonacute heart failure syndrome patients. URGENT was a prospective multicenter trial designed to address these issues. Methods Patients were interviewed within 1 hour of first physician evaluation, in the emergency department or acute care setting, with dyspnea assessed by the patient using both a five-point Likert scale and a 10-point visual analog scale (VAS) in the sitting (60º) and then supine (20º) position if dyspnea had not been considered severe or very severe by the sitting versus decubitus dyspnea measurement. Results Very good agreements were found between the five-point Likert and VAS at baseline (0.891, P <0.0001) and between changes (from baseline to hour 6) in the five-point Likert and in VAS (0.800, P <0.0001) in acute heart failure (AHF) patients. Lower agreements were found when changes from baseline to H6 measured by Likert or VAS were compared with the seven-point comparative Likert (0.512 and 0.500 respectively) in AHF patients. The worse the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours; this relationship is stronger when dyspnea is measured with VAS (Spearman's rho coefficient = 0.672) than with the five-point Likert (0.272) (both P <0.0001) in AHF patients. By the five-point Likert, only nine patients (3% (1% to 5%)) reported an improvement in their dyspnea, 177 (51% (46% to 57%)) had no change, and 159 (46% (41% to 52%)) reported worse dyspnea supine compared with sitting up in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Conclusions Both clinical tools five-point Likert and VAS showed very good agreement at baseline and between changes from baseline to tests performed 6 hours later in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Dyspnea is improved within 6 hours in more than threequarters of the patients regardless of the tool used to measure the change in dyspnea. The greater the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours.

Research paper thumbnail of Recommendations for the intra-hospital transport of critically ill patients

Critical Care, 2010

Introduction: This study was conducted to provide Intensive Care Units and Emergency Departments ... more Introduction: This study was conducted to provide Intensive Care Units and Emergency Departments with a set of practical procedures (check-lists) for managing critically-ill adult patients in order to avoid complications during intrahospital transport (IHT).

Research paper thumbnail of Overview of the current use of levosimendan in France: a prospective observational cohort study

Annals of Intensive Care

Background Following the results of randomized controlled trials on levosimendan, French health a... more Background Following the results of randomized controlled trials on levosimendan, French health authorities requested an update of the current use and side-effects of this medication on a national scale. Method The France-LEVO registry was a prospective observational cohort study reflecting the indications, dosing regimens, and side-effects of levosimendan, as well as patient outcomes over a year. Results The patients included (n = 602) represented 29.6% of the national yearly use of levosimendan in France. They were treated for cardiogenic shock (n = 250, 41.5%), decompensated heart failure (n = 127, 21.1%), cardiac surgery-related low cardiac output prophylaxis and/or treatment (n = 86, 14.3%), and weaning from veno-arterial extracorporeal membrane oxygenation (n = 82, 13.6%). They received 0.18 ± 0.07 µg/kg/min levosimendan over 26 ± 8 h. An initial bolus was administered in 45 patients (7.5%), 103 (17.1%) received repeated infusions, and 461 (76.6%) received inotropes and or vas...

Research paper thumbnail of Admission High-Sensitive Cardiac Troponin T Level Increase Is Independently Associated with Higher Mortality in Critically Ill Patients with COVID-19: A Multicenter Study

Journal of Clinical Medicine, 2021

Background: In coronavirus disease 2019 (COVID-19) patients, increases in high-sensitive cardiac ... more Background: In coronavirus disease 2019 (COVID-19) patients, increases in high-sensitive cardiac troponin T (hs-cTnT) have been reported to be associated with worse outcomes. In the critically ill, the prognostic value of hs-cTnT, however, remains to be assessed given that most previous studies have involved a case mix of non- and severely ill COVID-19 patients. Methods: We conducted, from March to May 2020, in three French intensive care units (ICUs), a multicenter retrospective cohort study to assess in-hospital mortality predictability of hs-cTnT levels in COVID-19 patients. Results: 111 laboratory-confirmed COVID-19 patients (68% of male, median age 67 (58–75) years old) were included. At ICU admission, the median Charlson Index, Simplified Acute Physiology Score II, and PaO2/FiO2 were at 3 (2–5), 37 (27–48), and 140 (98–154), respectively, and the median hs-cTnT serum levels were at 16.0 (10.1–31.9) ng/L. Seventy-five patients (68%) were mechanically ventilated, 41 (37%) were t...

Research paper thumbnail of French Intensive Care Society, International congress – Réanimation 2016

Annals of Intensive Care, 2016

Research paper thumbnail of SeverePlasmodium malariaeMalaria in a Patient With Multiple Susceptibility Genes

Journal of Travel Medicine, May 1, 2010

Research paper thumbnail of ResearchRecommendations for the intra-hospital transport of critically ill patients

Introduction: This study was conducted to provide Intensive Care Units and Emergency Departments ... more Introduction: This study was conducted to provide Intensive Care Units and Emergency Departments with a set of practical procedures (check-lists) for managing critically-ill adult patients in order to avoid complications during intrahospital transport (IHT). Methods: Digital research was carried out via the MEDLINE, EMBASE, CINAHL and HEALTHSTAR databases using the following key words: transferring, transport, intrahospital or intra-hospital, and critically ill patient. The reference bibliographies of each of the selected articles between 1998 and 2009 were also studied. Results: This review focuses on the analysis and overcoming of IHT-related risks, the associated adverse events, and their nature and incidence. The suggested preventive measures are also reviewed. A check-list for quick execution of IHT is then put forward and justified. Conclusions: Despite improvements in IHT practices, significant risks are still involved. Basic training, good clinical sense and a risk-benefit a...

Research paper thumbnail of Recommendations for the intra-hospital transport of critically ill patients

Critical Care, 2010

Introduction: This study was conducted to provide Intensive Care Units and Emergency Departments ... more Introduction: This study was conducted to provide Intensive Care Units and Emergency Departments with a set of practical procedures (check-lists) for managing critically-ill adult patients in order to avoid complications during intrahospital transport (IHT). Methods: Digital research was carried out via the MEDLINE, EMBASE, CINAHL and HEALTHSTAR databases using the following key words: transferring, transport, intrahospital or intra-hospital, and critically ill patient. The reference bibliographies of each of the selected articles between 1998 and 2009 were also studied. Results: This review focuses on the analysis and overcoming of IHT-related risks, the associated adverse events, and their nature and incidence. The suggested preventive measures are also reviewed. A checklist for quick execution of IHT is then put forward and justified. Conclusions: Despite improvements in IHT practices, significant risks are still involved. Basic training, good clinical sense and a risk-benefit analysis are currently the only deciding factors. A critically ill patient, prepared and accompanied by an inexperienced team, is a risky combination. The development of adapted equipment and the widespread use of checklists and proper training programmes would increase the safety of IHT and reduce the risks in the long-term. Further investigation is required in order to evaluate the protective role of such preventive measures.

Research paper thumbnail of Épuration de CO2 chez les patients ayant une défaillance rénale et respiratoire à l’aide d’une machine d’épuration extra-rénale classique

Annales Françaises d'Anesthésie et de Réanimation, 2013

Research paper thumbnail of Outcome of patients treated with molecular adsorbent recirculating system albumin dialysis: A national multicenter study

JGH Open, 2020

Background and Aim: The molecular adsorbent recirculating system (MARS) is the most widely used d... more Background and Aim: The molecular adsorbent recirculating system (MARS) is the most widely used device to treat liver failure. Nevertheless, data from widespread real-life use are lacking. Methods: This was a retrospective multicenter study conducted in all French adult care centers that used MARS between 2004 and 2009. The primary objective was to evaluate patient survival according to the liver disease and listing status. Factors associated with mortality were the secondary objectives. Results: A total of 383 patients underwent 393 MARS treatments. The main indications were acute liver failure (ALF, 32.6%), and severe cholestasis (total bilirubin >340 μmol/L) (37.2%), hepatic encephalopathy (23.7%), and/or acute kidney injuryhepatorenal syndrome (22.9%) most often among patients with chronic liver disease. At the time of treatment, 34.4% of the patients were listed. Overall, the hospital survival rate was 49% (95% CI: 44-54%) and ranged from 25% to 81% depending on the diagnosis of the liver disease. In listed patients versus those not listed, the 1-year survival rate was markedly better in the setting of nonbiliary cirrhosis (59% vs 15%), early graft nonfunction (80% vs 0%), and late graft dysfunction (72% vs 0%) (all P < 0.001). Among nonbiliary cirrhotic patients, hospital mortality was associated with the severity of liver disease (HE and severe cholestasis) and not being listed for transplant. In ALF, paracetamol etiology and ≥3 MARS sessions were associated with better transplant-free survival. Conclusion: Our study suggests that MARS should be mainly used as a bridge to liver transplantation. Survival was correlated with being listed for most etiologies and with the intensity of treatment in ALF.

Research paper thumbnail of Plasma citrulline kinetics and prognostic value in critically ill patients

European Journal of Intensive Care Medicine, Jan 19, 2010

There is considerable uncertainty about the reproducibility of the various instruments used to me... more There is considerable uncertainty about the reproducibility of the various instruments used to measure dyspnea, their ability to reflect changes in symptoms, whether they accurately reflect the patient's experience and if its evolution is similar between acute heart failure syndrome patients and nonacute heart failure syndrome patients. URGENT was a prospective multicenter trial designed to address these issues. Methods Patients were interviewed within 1 hour of first physician evaluation, in the emergency department or acute care setting, with dyspnea assessed by the patient using both a five-point Likert scale and a 10-point visual analog scale (VAS) in the sitting (60º) and then supine (20º) position if dyspnea had not been considered severe or very severe by the sitting versus decubitus dyspnea measurement. Results Very good agreements were found between the five-point Likert and VAS at baseline (0.891, P <0.0001) and between changes (from baseline to hour 6) in the five-point Likert and in VAS (0.800, P <0.0001) in acute heart failure (AHF) patients. Lower agreements were found when changes from baseline to H6 measured by Likert or VAS were compared with the seven-point comparative Likert (0.512 and 0.500 respectively) in AHF patients. The worse the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours; this relationship is stronger when dyspnea is measured with VAS (Spearman's rho coefficient = 0.672) than with the five-point Likert (0.272) (both P <0.0001) in AHF patients. By the five-point Likert, only nine patients (3% (1% to 5%)) reported an improvement in their dyspnea, 177 (51% (46% to 57%)) had no change, and 159 (46% (41% to 52%)) reported worse dyspnea supine compared with sitting up in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Conclusions Both clinical tools five-point Likert and VAS showed very good agreement at baseline and between changes from baseline to tests performed 6 hours later in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Dyspnea is improved within 6 hours in more than threequarters of the patients regardless of the tool used to measure the change in dyspnea. The greater the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours.

Research paper thumbnail of partial EC CO2 removal - 2014

To test the feasibility, safety, and efficacy of partial extracorporeal CO 2 removal (PECCO 2 R) ... more To test the feasibility, safety, and efficacy of partial extracorporeal CO 2 removal (PECCO 2 R) using a standard continuous renal replacement (CRRT) device with a pediatric oxygenation membrane introduced into the circuit in a serial manner. In this retrospective single-center study, we have studied mechanically ventilated patients with persistent significant respiratory acidosis and acute renal failure requiring ongoing CRRT. Sixteen patients were treated with our PECCO 2 R device. PaCO 2 and arterial pH were measured before as well as at 6 and 12 hours after PECCO 2 R implementation. Hemodynamic parameters were continuously monitored. Our PEC-CO 2 R system was efficient to significantly reduce PaCO 2 and increase arterial pH. The median PaCO 2 before treatment was 77 mm Hg (59-112) with a median reduction of 24 mm Hg after 6 hours and 30 mm Hg after 12 hours (31% and 39%, respectively). The median pH increase was 0.16 at 6 hours and 0.23 at 12 hours. Partial extracorporeal CO 2 removal treatment had no effect on oxygenation. No complication was observed. Our PECCO 2 R approach based on the simple introduction of a pediatric extracorporeal membrane oxygenation membrane into the circuit of a standard CRRT device is easy to implement, safe, and efficient to improve respiratory acidosis. ASAIO Journal 2014; XX:00-00.

Research paper thumbnail of Capillary lactate as a tool for the triage nurse among patients with SIRS at emergency department presentation: a preliminary report

Annals of intensive care, 2015

The triage nurse is involved in the early identification of the most severe patients at emergency... more The triage nurse is involved in the early identification of the most severe patients at emergency department (ED) presentation. However, clinical criteria alone may be insufficient to identify them correctly. Measurement of capillary lactate concentration at ED presentation may help to discriminate these patients. The primary objective of this study was to identify the prognostic value of capillary lactate concentration measured by the triage nurse among patients presenting to the ED. This was a prospective observational study, performed in the ED of a university hospital. At ED presentation, capillary lactate measurement was performed by the triage nurse among patients presenting with a clinical criteria of systemic inflammatory response syndrome (SIRS). Clinical variables usually used to determine severity were collected at presentation. Twenty-eight-day mortality and MEDS score were recorded. One hundred seventy-six patients with clinical SIRS presented to the ED. Median age was ...

Research paper thumbnail of Partial Extracorporeal Carbon Dioxide Removal Using a Standard Continuous Renal Replacement Therapy Device

Research paper thumbnail of Acute ischemic pancreatitis following cardiac arrest: a case report

JOP : Journal of the pancreas, 2010

Ischemia is an established cause of acute pancreatitis; however, acute pancreatitis has never bee... more Ischemia is an established cause of acute pancreatitis; however, acute pancreatitis has never been reported after cardiac arrest. We report a case of acute pancreatitis following cardiac arrest with prolonged cardiopulmonary resuscitation in a 58-year-old man, the mechanism of which is likely to be ischemic. The patient developed severe ischemic encephalopathy, leading to death. Possible causes of acute pancreatitis in a context of cardiopulmonary resuscitation are discussed. In case of abdominal distension following cardiac arrest, diagnoses of mesenteric ischemia and acute ischemic pancreatitis should be considered. Such digestive complications occurring after cardiac arrest probably reflect the severity of the ischemia.

Research paper thumbnail of Circulations extracorporelles d’assistance respiratoire en réanimation chez l’adulte

Réanimation, 2009

ABSTRACT Since its first description, the care of the acute respiratory distress syndrome has con... more ABSTRACT Since its first description, the care of the acute respiratory distress syndrome has considerably changed. While pathophysiology remain a subject to debate and intensive research, the use of high tidal volume and airway pressure has been demonstrated to be harmful. Extracorporeal membrane oxygenation (ECMO) technics are able to remove carbon dioxide allowing gentle ventilation. According to the technic used, oxygenation and hemodynamic stability may be achieved. Several case reports have been published in the past and recent literature, however two prospective randomised trials failed to demonstrate an impact on survival rate. Heavily discussed on technics, experience and management of the teams involved in these study and according to new developments and concepts, several studies are waiting publication or under way. Extracorporeal membrane oxygenation is indicated as part of global strategy with dedicated and trained team to avoid complications and after referral if necessary.

Research paper thumbnail of Severe Plasmodium malariae Malaria in a Patient With Multiple Susceptibility Genes

Journal of Travel Medicine, 2010

We present a case of severe malaria due to Plasmodium malariae. Genetic testing showed that the p... more We present a case of severe malaria due to Plasmodium malariae. Genetic testing showed that the patient was homozygous for five important gene polymorphisms previously shown to be associated with increased susceptibility to, and/or severity of, severe sepsis. Our case suggests that P. malariae may cause life-threatening disease, and that disease severity may be linked, at least in part, to multiple susceptibility genes.

Research paper thumbnail of 274 THE CRP LEVEL IS A GOOD PREDICTOR OF MORTALITY INDEPENDENT OF PUGH OR MELD SCORES IN PATIENTS WITH END STAGE LIVER DISEASE (ESLD)

Journal of Hepatology, 2008

Bleeding from esophageal varices is a serious complication of portal hypertension, which still ca... more Bleeding from esophageal varices is a serious complication of portal hypertension, which still carries significant mortality. After control of the initial hemorrhage, early rebleeding remains a risk. Whether measures assessing liver disease severity and calculated fibrosis scores can assist in predicting outcome in patients with acute variceal bleeding is investigated in this study. Methods: Acute variceal bleeding was managed endoscopically in 965 patients (761 males, 204 females, mean age 52.6 years). All patients received antibiotic prophylaxis, and were followed for the occurrence of early rebleeding for 5 days if bleeding was controlled or till discharge. Patients had their Child score, MELD score, AST/ALT ratio, age-platelet index, APRI index, Phol's score, cirrhosis discriminant score (CDS) and Göteborg University cirrhosis index (GUCI) calculated on admission, and correlated to the outcome of initial bleeding and rebleeding if bleeding was controlled. Results: Mortality increased with increasing Child score: (0%, 2.4%, and 28% in Child A, B, and C, p < 0.001)) and MELD score (1.1%, 3.7%, 10%, and 48% in MELD 11; 12−15; 16−19; and 20 p < 0.001)). A cutoff of 20 for MELD had a sensitivity of 81.5% and specificity of 80.7% for predicting mortality and a cutoff of 10 for Child score had 80% sensitivity and 81.4% specificity. MELD and Child scores and the presence of encephalopathy had the highest power for predicting outcome (AUC = 0.889, 0.891, 0.886 respectively p < 0.001). AST/ALT ratio, ageplatelet index, APRI index, Phol's score, CDS and GUCI scores had lower discriminative power than MELD and CTP scores. Similarly, rebleeding increased with increasing Child and MELD scores. A shorter time between admission and endoscopy was a significant factor determining better survival and less rebleeding in patients with high Child and Meld scores. Conclusion: Increasing MELD and CTP scores and the presence of encephalopathy are associated with high mortality in acute variceal bleeding and can be used as predictors of outcome. Other indices of fibrosis have significantly less discriminant value and have no role in predicting outcome. Urgent endoscopy remains a very important therapeutic intervention and should be offered earlier with patients with higher scores.

Research paper thumbnail of C-Reactive protein predicts short-term mortality in patients with cirrhosis

Journal of Hepatology, 2012

Background & Aims: We aimed at improving prediction of shortterm mortality in cirrhotic inpatient... more Background & Aims: We aimed at improving prediction of shortterm mortality in cirrhotic inpatients by evaluating C-reactive protein (CRP) as a surrogate marker of systemic inflammatory response syndrome (SIRS). Methods: One-hundred and forty-eight consecutive cirrhotic patients with Child-Pugh score PB8 and without hepatocellular carcinoma were prospectively included and followed for 182 days. The primary end point was 6-month survival. Results: Main baseline characteristics were as follows: alcoholic liver disease in 88.5%; bacterial infection in 37%; hepatorenal syndrome in 7% of cases. CRP range was 1-240 mg/L (median 26 mg/L); 42 patients (28.4%) had SIRS as defined by ACCP/ SCCM-criteria. CRP levels were higher in patients with SIRS (50 vs. 21 mg/L; p <0.0001), infection (46 vs. 27 mg/L; p <0.0001), and alcoholic hepatitis (44 vs. 32 mg/L, p = 0.049). Forty-two patients died within the first 6 months of follow-up. Short-term mortality was associated with extrahepatic co-morbidities (p = 0.002), high MELD score (p <0.001; AUROC = 0.67), renal failure (p = 0.008), elevated blood lactates (p <0.001), and high baseline CRP levels (p = 0.003; AUROC = 0.63; best cut-off value at 29 mg/L). Among patients with baseline CRP P29 mg/L, 32 still had CRP P29 mg/L at day 15 (group A). Group A was associated with 6-month mortality in the overall population (p <0.001) and also through sentitivity analyses restricted to patients without infection or alcoholic hepatitis. Multivariate analysis (Cox) adjusted for age identified three predictors of mortality: high MELD score (HR = 1.08; 95% CI: 1.03-1.12; p <0.001), extrahepatic co-morbidities (HR = 2.51; 95% CI: 1.31-4.84; p = 0.006), and CRP level (group A) (HR = 2.73; 95% CI: 1.41-5.26; p = 0.003). The performance of the three variables taken together for predicting death was 0.80 (AUROC). Conclusions: In Child-Pugh score PB8 cirrhotic patients, persistent CRP levels P29 mg/L predicted short-term mortality independently of age, MELD, and co-morbidities, and better than infection or clinically-assessed SIRS. Ó

Research paper thumbnail of Plasma citrulline kinetics and prognostic value in critically ill patients

Intensive Care Medicine, 2010

Research paper thumbnail of Plasma citrulline kinetics and prognostic value in the critically ill patient

Critical Care, 2009

There is considerable uncertainty about the reproducibility of the various instruments used to me... more There is considerable uncertainty about the reproducibility of the various instruments used to measure dyspnea, their ability to reflect changes in symptoms, whether they accurately reflect the patient's experience and if its evolution is similar between acute heart failure syndrome patients and nonacute heart failure syndrome patients. URGENT was a prospective multicenter trial designed to address these issues. Methods Patients were interviewed within 1 hour of first physician evaluation, in the emergency department or acute care setting, with dyspnea assessed by the patient using both a five-point Likert scale and a 10-point visual analog scale (VAS) in the sitting (60º) and then supine (20º) position if dyspnea had not been considered severe or very severe by the sitting versus decubitus dyspnea measurement. Results Very good agreements were found between the five-point Likert and VAS at baseline (0.891, P <0.0001) and between changes (from baseline to hour 6) in the five-point Likert and in VAS (0.800, P <0.0001) in acute heart failure (AHF) patients. Lower agreements were found when changes from baseline to H6 measured by Likert or VAS were compared with the seven-point comparative Likert (0.512 and 0.500 respectively) in AHF patients. The worse the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours; this relationship is stronger when dyspnea is measured with VAS (Spearman's rho coefficient = 0.672) than with the five-point Likert (0.272) (both P <0.0001) in AHF patients. By the five-point Likert, only nine patients (3% (1% to 5%)) reported an improvement in their dyspnea, 177 (51% (46% to 57%)) had no change, and 159 (46% (41% to 52%)) reported worse dyspnea supine compared with sitting up in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Conclusions Both clinical tools five-point Likert and VAS showed very good agreement at baseline and between changes from baseline to tests performed 6 hours later in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Dyspnea is improved within 6 hours in more than threequarters of the patients regardless of the tool used to measure the change in dyspnea. The greater the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours.

Research paper thumbnail of Recommendations for the intra-hospital transport of critically ill patients

Critical Care, 2010

Introduction: This study was conducted to provide Intensive Care Units and Emergency Departments ... more Introduction: This study was conducted to provide Intensive Care Units and Emergency Departments with a set of practical procedures (check-lists) for managing critically-ill adult patients in order to avoid complications during intrahospital transport (IHT).