Pierre-françois Dequin - Academia.edu (original) (raw)
Papers by Pierre-françois Dequin
Presse médicale (Paris, France : 1983), 2006
Intravesical bacillus Calmette-Guerin (BCG) therapy, recommended for superficial bladder tumors, ... more Intravesical bacillus Calmette-Guerin (BCG) therapy, recommended for superficial bladder tumors, triggers side effects in fewer than 5% of patients. The most severe side effects, however, are septic shock and acute respiratory failure. A 70-year-old man was hospitalized for septic shock with acute respiratory and renal failure after intravesical instillation of BCG, which was identified in the gastric aspiration sample. Treatment with rifampicin, ethambutol, isoniazid, and corticosteroid therapy, as well as standard reanimation measures, led to the patient's recovery. This case shows the potentially severe side effects of intravesical BCG instillation. Although this treatment is well tolerated in more than 95% of patients and its systemic complications can be effectively treated, these side effects can be life-threatening.
La Presse Médicale
This prospective study was conducted to evaluate the usefulness of venous lactate assay in the di... more This prospective study was conducted to evaluate the usefulness of venous lactate assay in the diagnosis of generalized seizures. Over a three month period, 78 consecutive adults admitted to the emergency unit for unconsciousness were included in the study. Three study groups were defined: patients with generalized seizures (n = 22), unconscious patients without seizure (n = 34) and known epileptic patients with unexplained malaises (n = 22). Patients with a disease susceptible of increasing lactate levels were excluded. Peripheral venous blood was drawn to determine lactates, bicarbonates and pH on a blood gas analyzer. All determinations were performed within 5 minutes of blood withdrawal. CPK level was also determined with an enzymatic method. In patients who had seizures, venous lactate levels were higher than those in patients who had no seizures: 4.3 +/- 0.5 mmol/l in generalized seizure patients versus 1.64 +/- 0.1 and 2.2 +/- 1.39 in unconscious patients without seizure and ...
Introduction: Fluid responsiveness prediction is of utmost interest during acute respiratory dist... more Introduction: Fluid responsiveness prediction is of utmost interest during acute respiratory distress syndrome (ARDS), but the performance of respiratory pulse pressure variation (Δ RESP PP) has scarcely been reported. In patients with ARDS, the pathophysiology of Δ RESP PP may differ from that of healthy lungs because of low tidal volume (Vt), high respiratory rate, decreased lung and sometimes chest wall compliance, which increase alveolar and/or pleural pressure. We aimed to assess Δ RESP PP in a large ARDS population. Methods: Our study population of nonarrhythmic ARDS patients without inspiratory effort were considered responders if their cardiac output increased by >10% after 500-ml volume expansion. Results: Among the 65 included patients (26 responders), the area under the receiver-operating curve (AUC) for Δ RESP PP was 0.75 (95% confidence interval (CI 95 ): 0.62 to 0.85), and a best cutoff of 5% yielded positive and negative likelihood ratios of 4.8 (CI 95 : 3.6 to 6.2) and 0.32 (CI 95 : 0.1 to 0.8), respectively. Adjusting Δ RESP PP for Vt, airway driving pressure or respiratory variations in pulmonary artery occlusion pressure (ΔPAOP), a surrogate for pleural pressure variations, in 33 Swan-Ganz catheter carriers did not markedly improve its predictive performance. In patients with ΔPAOP above its median value (4 mmHg), AUC for Δ RESP PP was 1 (CI 95 : 0.73 to 1) as compared with 0.79 (CI 95 : 0.52 to 0.94) otherwise (P = 0.07). A 300-ml volume expansion induced a ≥2 mmHg increase of central venous pressure, suggesting a change in cardiac preload, in 40 patients, but none of the 28 of 40 nonresponders responded to an additional 200-ml volume expansion. Conclusions: During protective mechanical ventilation for early ARDS, partly because of insufficient changes in pleural pressure, Δ RESP PP performance was poor. Careful fluid challenges may be a safe alternative.
To determine predictors of mortality in the intensive care unit (ICU) and at 6 months after disch... more To determine predictors of mortality in the intensive care unit (ICU) and at 6 months after discharge; to assess the lifestyles of survivors 6 months after discharge. Prospective cohort study of patients screened upon admission and 6 months after discharge from the ICU. The ICU of a university hospital. One hundred sixteen consecutive patients age 70 and older admitted to the ICU and treated by mechanical ventilation for at least 24 hours. A comprehensive medical, functional, nutritional, and social assessment was undertaken for each patient upon admission to the ICU. Functional status and residence were recorded for patients still living 6 months after discharge from the ICU. Mortality in the ICU and 6 months after discharge was 31% and 52%, respectively. The predictors of in-ICU mortality on multivariate analysis were a high omega score per day in the ICU and a high simplified acute physiologic score corrected for points related to age (SAPS IIc). The predictors of mortality at 6 months were a high omega score per day in the ICU, a high SAPS IIc, and a mid-arm circumference (MAC) under the 10th percentile for the older French population in good health. Six months after discharge from the ICU, 91% of the surviving patients had the same residential status and 89% had a similar or improved functional status compared with pre-admission status. Although severity of illness remains an important predictor of in-ICU mortality and mortality at 6 months after release from ICU, we found that impaired nutritional status upon admission was related to 6-month mortality. These results emphasize the need for a systematic nutritional assessment in older patients admitted to the ICU and treated by mechanical ventilation.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2015
Background: Meta-analyses of nonrandomized studies have provided conflicting data on therapeutic ... more Background: Meta-analyses of nonrandomized studies have provided conflicting data on therapeutic hypothermia, or targeted temperature management (TTM), at 33°C in patients successfully resuscitated after nonshockable cardiac arrest. Nevertheless, the latest recommendations issued by the International Liaison Committee on Resuscitation and by the European Resuscitation Council recommend therapeutic hypothermia. New data are available on the adverse effects of therapeutic hypothermia, notably infectious complications. The risk/benefit ratio of therapeutic hypothermia after nonshockable cardiac arrest is unclear.
Intensive Care Medicine, 2014
La Presse Médicale, 2006
■ Summary Acute respiratory failure and septic shock induced by Mycobacterium bovis A rare side e... more ■ Summary Acute respiratory failure and septic shock induced by Mycobacterium bovis A rare side effect of intravesical BCG therapy Introduction > Intravesical bacillus Calmette-Guerin (BCG) therapy, recommended for superficial bladder tumors, triggers side effects in fewer than 5% of patients. The most severe side effects, however, are septic shock and acute respiratory failure. Case > A 70-year-old man was hospitalized for septic shock with acute respiratory and renal failure after intravesical instillation of BCG, which was identified in the gastric aspiration sample. Treatment with rifampicin, ethambutol, isoniazid, and corticosteroid therapy, as well as standard reanimation measures, led to the patient's recovery. Discussion > This case shows the potentially severe side effects of intravesical BCG instillation. Although this treatment is well tolerated in more than 95% of patients and its systemic complications can be effectively treated, these side effects can be life-threatening. Rival G, Garot D, Mercier E, Narciso B, Legras A, Perrotin D et al. Atteinte respiratoire sévère et choc septique à Mycobacterium bovis. Une complication rare de la BCG thérapie intravésicale.
Critical Care, 2014
In septic shock patients, the prevalence of low (<70%) central venous oxygen saturation (ScvO2) o... more In septic shock patients, the prevalence of low (<70%) central venous oxygen saturation (ScvO2) on admission to the intensive care unit (ICU) and its relationship to outcome are unknown. The objectives of the present study were to estimate the prevalence of low ScvO2 in the first hours of ICU admission and to assess its potential association with mortality in patients with severe sepsis or septic shock. Methods: This was a prospective, multicentre, observational study conducted over a one-year period in ten French ICUs. Clinicians were asked to include patients with severe sepsis or septic shock preferably within 6 hours of ICU admission and as soon as possible without changing routine practice. ScvO2 was measured at inclusion and 6 hours later (H6), by blood sampling.
Journal of Critical Care, 2009
Data regarding outcome of patients with chronic liver disease with severe hepatic encephalopathy ... more Data regarding outcome of patients with chronic liver disease with severe hepatic encephalopathy in intensive care unit are currently scarce. This study is a retrospective observational case series in a medical intensive care unit (ICU) in a university hospital from 1995 to 2005. Patients with hepatic encephalopathy (HE) (admitted with or developing) were identified. Clinical and laboratory parameters were analyzed to determinate predictors of ICU and 1-year mortality. Seventy-one patients were included (53 male). Median Simplified Acute Physiology Score was 56 with Child-Pugh score 11 +/- 2. Seventy-six percent of patients were admitted with coma (Glasgow Coma Scale, 7.7 +/- 4). Eighty-two percent of patients required intubation, and 28% vasopressors. Thirty-five percent died during ICU stay. At 1 year, mortality was 54%. Univariate analysis identified arterial hypotension, mechanical ventilation, vasopressors at any time, acute renal failure, Simplified Acute Physiology Score, and sepsis associated with ICU mortality. In multivariate analysis, vasopressor use or acute renal failure was the main independent predictor of ICU death and 1-year mortality. Patients free of these risk factors, even requiring intubation, were identified as isolated HE, with lower mortality rates. Predictors of outcome were similar to other groups of patients with liver disease admitted for other reasons. Intensive care unit mortality was lower than reported for other groups of patients with similar illness. Patients with severe HE admitted to ICU with no organ dysfunction other than mechanical ventilation had a better outcome and may require ICU admission.
Journal of Aerosol Medicine and Pulmonary Drug Delivery, 2009
The fraction of inspired oxygen (FiO 2 ) during oxygen-driven jet nebulization is unknown. In the... more The fraction of inspired oxygen (FiO 2 ) during oxygen-driven jet nebulization is unknown. In the case of air-driven jet nebulization, oxygen is often added through a nasal device, and again, the FiO 2 is unknown. The aim of this experimental study was to measure FiO 2 during oxygen-and air-driven jet nebulization, oxygen being added through a nasal device, and to compare the values observed with those measured during standard oxygen therapy. Methods: An endotracheal tube was inserted into the distal tracheal extremity of a cadaveric head and neck specimen and connected to a pump, simulating different respiratory patterns. FiO 2 was measured using an electrochemical oxygen analyzer under different nebulization and oxygen delivery conditions. Variables were compared using canonical analysis and analysis of simple and multiple variance. Results: FiO 2 was significantly influenced by the mode of oxygen delivery (p ϭ 0.001). The highest FiO 2 was observed when oxygen was delivered via a nasopharyngeal catheter associated with air-driven jet nebulization. For oxygen flow rates of 12 and 15 L/min, a nasal cannula combined with air-driven jet nebulization resulted in a similar FiO 2 . The FiO 2 was significantly lower in the case of oxygen-driven jet nebulization. The FiO 2 decreased with increasing respiratory rate (p Ͻ 0.001) and tidal volume (p Ͻ 0.001). Conclusions: Oxygen delivery through a nasal device during air-driven jet nebulization significantly increases the FiO 2 , whereas oxygen-driven jet nebulization dramatically decreases FiO 2 compared with standard oxygen therapy.
Journal of Aerosol Medicine, 1997
Page 1. JOURNAL OF AEROSOL MEDICINE Volume 10, Number 3, 1997 Mary Ann Liebert, Inc. Pp. 221-230 ... more Page 1. JOURNAL OF AEROSOL MEDICINE Volume 10, Number 3, 1997 Mary Ann Liebert, Inc. Pp. 221-230 Characterization on the Bench of an Amikacin Aerosol Before Clinical Studies PIERRE-FRANÇOIS DEQUIN,1 FRÉDÉRIQUE ...
Intensive Care Medicine, 2010
Objective: To determine the incidence, risk factors, severity, and preventability of iatrogenic e... more Objective: To determine the incidence, risk factors, severity, and preventability of iatrogenic events (IEs) as a cause of intensive care unit (ICU) admission. Design: Comparison of patients admitted or not for IE. IE was diagnosed after assessing independently predefined criteria. Setting: The ICU of a teaching hospital. Patients: All patients consecutively admitted over 6 months. Interventions: None. Measurements and results: Characteristics of patients, supportive treatments, length of stay, and outcomes were recorded. For patients admitted for IE, cause, origin, and preventability of IE were assessed by consensus. Of 528 patients, 103 (19.5%) were admitted for IE. Their Simplified Acute Physiology Score (SAPS) II was higher (41.2 ± 22.6 versus 31.4 ± 18.6), as was their Logistic Organ Dysfunction (LOD) score. Surgical admissions and admission for shock were more frequent. The main risk factors were age, underlying disease, low Mac Cabe or Knaus score, number of physicians treating the patient, number of drugs prescribed, and other hospitalization within 1 month. Length of stay was higher (11.1 days versus 7.9 days, 0.5-6.0, p = 0.02). Catecholamine drugs, blood transfusion, and parenteral nutrition were more frequently required in the IE group. ICU mortality was 15.5% in the IE group and 11.3% in the group without IEs [not significant (ns) after adjustment]. IE was considered as probably preventable in 73.8% of cases. Conclusion: Of admissions to the ICU, 19.5% resulted from IE, with high proportion of shock, leading to greater need for invasive treatments and longer stay in the ICU. Most cases of IE seemed preventable.
Critical Care, 2011
Introduction: Fluid responsiveness prediction is of utmost interest during acute respiratory dist... more Introduction: Fluid responsiveness prediction is of utmost interest during acute respiratory distress syndrome (ARDS), but the performance of respiratory pulse pressure variation (Δ RESP PP) has scarcely been reported. In patients with ARDS, the pathophysiology of Δ RESP PP may differ from that of healthy lungs because of low tidal volume (Vt), high respiratory rate, decreased lung and sometimes chest wall compliance, which increase alveolar and/or pleural pressure. We aimed to assess Δ RESP PP in a large ARDS population. Methods: Our study population of nonarrhythmic ARDS patients without inspiratory effort were considered responders if their cardiac output increased by >10% after 500-ml volume expansion. Results: Among the 65 included patients (26 responders), the area under the receiver-operating curve (AUC) for Δ RESP PP was 0.75 (95% confidence interval (CI 95 ): 0.62 to 0.85), and a best cutoff of 5% yielded positive and negative likelihood ratios of 4.8 (CI 95 : 3.6 to 6.2) and 0.32 (CI 95 : 0.1 to 0.8), respectively. Adjusting Δ RESP PP for Vt, airway driving pressure or respiratory variations in pulmonary artery occlusion pressure (ΔPAOP), a surrogate for pleural pressure variations, in 33 Swan-Ganz catheter carriers did not markedly improve its predictive performance. In patients with ΔPAOP above its median value (4 mmHg), AUC for Δ RESP PP was 1 (CI 95 : 0.73 to 1) as compared with 0.79 (CI 95 : 0.52 to 0.94) otherwise (P = 0.07). A 300-ml volume expansion induced a ≥2 mmHg increase of central venous pressure, suggesting a change in cardiac preload, in 40 patients, but none of the 28 of 40 nonresponders responded to an additional 200-ml volume expansion. Conclusions: During protective mechanical ventilation for early ARDS, partly because of insufficient changes in pleural pressure, Δ RESP PP performance was poor. Careful fluid challenges may be a safe alternative.
Critical Care, 2011
AKI, acute kidney injury; FG, fi ltration gradient; IAP, intra-abdominal pressure; MAP, mean arte... more AKI, acute kidney injury; FG, fi ltration gradient; IAP, intra-abdominal pressure; MAP, mean arterial pressure.
Clinical Toxicology, 1996
To describe fatal herbicide poisoning with Radoxone TL composed of aminotriazole and ammonium thi... more To describe fatal herbicide poisoning with Radoxone TL composed of aminotriazole and ammonium thiocyanate. A 54-year-old man was hospitalized because of unexplained coma with myoclonic jerks and vascular collapse. Despite symptomatic treatment with mechanical ventilation and vascular filling, life-threatening shock occurred with oliguria, profound metabolic acidosis and cardiac arrest. Hyperchloremia (141 mmol/L) with reversed anion gap (-19) suggested interference with chloride measurement caused by halogens (Br,F,I) or other anions such as thiocyanate. Eventually a weed killer, Radoxone TL containing ammonium thiocyanate, was found at the patient's house. Thiocyanate and aminotriazole blood levels were 750 mg/L and 138 mg/L respectively more than 12 hours after ingestion. After prolonged cardiopulmonary resuscitation, continuous venovenous hemodiafiltration was performed. Despite hemodynamic recovery the patient died 48 hours later of postanoxic coma. Aminotriazole, a systemic nonselective herbicide, is often associated with ammonium thiocyanate which enhances its activity. Experimental studies and previous fatal cases suggest a predominant toxicity of thiocyanate. Early diagnosis is important.
Anesthesia & Analgesia, 2009
Arterial cannulation is strongly recommended during shock. Nevertheless, this procedure is associ... more Arterial cannulation is strongly recommended during shock. Nevertheless, this procedure is associated with significant risks and may delay other emergent procedures. We assessed the discriminative power of brachial cuff oscillometric noninvasive blood pressure (NIBP) for identifying patients with an invasive mean arterial blood pressure (MAP) below 65 mm Hg or increasing their invasive MAP after cardiovascular interventions. This prospective study, conducted in three intensive care units, included adults in circulatory failure who underwent 45 degrees passive leg raising, 300 mL fluid loading, and additional 200 mL fluid loading. The collected data were four invasive and noninvasive MAP measurements at each study phase. Among 111 patients (50 septic, 15 cardiogenic, and 46 other source of shock), when averaging measurements of each study phase, NIBP measurements accurately predicted an invasive MAP lower than 65 mm Hg: area under the receiver operating characteristic curve 0.90 (95% CI: 0.71-1), positive and negative likelihood ratios 7.7 (95% CI: 5.4-11) and 0.31 (95% CI: 0.22-0.44) (cutoff 65 mm Hg). For identifying patients increasing their invasive MAP by more than 10%, the area under the receiver operating characteristic curve was 0.95 (95% CI: 0.92-0.96); positive and negative likelihood ratios (cutoff 10%) were 25.7 (95% CI: 10.8-61.4) and 0.26 (95% CI: 0.2-0.34). NIBP measurements have a good discriminative power for identifying hypotensive patients and performed even better in tracking MAP changes, provided that one averages four NIBP measurements.
Annales Françaises d'Anesthésie et de Réanimation, 2013
Presse médicale (Paris, France : 1983), 2006
Intravesical bacillus Calmette-Guerin (BCG) therapy, recommended for superficial bladder tumors, ... more Intravesical bacillus Calmette-Guerin (BCG) therapy, recommended for superficial bladder tumors, triggers side effects in fewer than 5% of patients. The most severe side effects, however, are septic shock and acute respiratory failure. A 70-year-old man was hospitalized for septic shock with acute respiratory and renal failure after intravesical instillation of BCG, which was identified in the gastric aspiration sample. Treatment with rifampicin, ethambutol, isoniazid, and corticosteroid therapy, as well as standard reanimation measures, led to the patient's recovery. This case shows the potentially severe side effects of intravesical BCG instillation. Although this treatment is well tolerated in more than 95% of patients and its systemic complications can be effectively treated, these side effects can be life-threatening.
La Presse Médicale
This prospective study was conducted to evaluate the usefulness of venous lactate assay in the di... more This prospective study was conducted to evaluate the usefulness of venous lactate assay in the diagnosis of generalized seizures. Over a three month period, 78 consecutive adults admitted to the emergency unit for unconsciousness were included in the study. Three study groups were defined: patients with generalized seizures (n = 22), unconscious patients without seizure (n = 34) and known epileptic patients with unexplained malaises (n = 22). Patients with a disease susceptible of increasing lactate levels were excluded. Peripheral venous blood was drawn to determine lactates, bicarbonates and pH on a blood gas analyzer. All determinations were performed within 5 minutes of blood withdrawal. CPK level was also determined with an enzymatic method. In patients who had seizures, venous lactate levels were higher than those in patients who had no seizures: 4.3 +/- 0.5 mmol/l in generalized seizure patients versus 1.64 +/- 0.1 and 2.2 +/- 1.39 in unconscious patients without seizure and ...
Introduction: Fluid responsiveness prediction is of utmost interest during acute respiratory dist... more Introduction: Fluid responsiveness prediction is of utmost interest during acute respiratory distress syndrome (ARDS), but the performance of respiratory pulse pressure variation (Δ RESP PP) has scarcely been reported. In patients with ARDS, the pathophysiology of Δ RESP PP may differ from that of healthy lungs because of low tidal volume (Vt), high respiratory rate, decreased lung and sometimes chest wall compliance, which increase alveolar and/or pleural pressure. We aimed to assess Δ RESP PP in a large ARDS population. Methods: Our study population of nonarrhythmic ARDS patients without inspiratory effort were considered responders if their cardiac output increased by >10% after 500-ml volume expansion. Results: Among the 65 included patients (26 responders), the area under the receiver-operating curve (AUC) for Δ RESP PP was 0.75 (95% confidence interval (CI 95 ): 0.62 to 0.85), and a best cutoff of 5% yielded positive and negative likelihood ratios of 4.8 (CI 95 : 3.6 to 6.2) and 0.32 (CI 95 : 0.1 to 0.8), respectively. Adjusting Δ RESP PP for Vt, airway driving pressure or respiratory variations in pulmonary artery occlusion pressure (ΔPAOP), a surrogate for pleural pressure variations, in 33 Swan-Ganz catheter carriers did not markedly improve its predictive performance. In patients with ΔPAOP above its median value (4 mmHg), AUC for Δ RESP PP was 1 (CI 95 : 0.73 to 1) as compared with 0.79 (CI 95 : 0.52 to 0.94) otherwise (P = 0.07). A 300-ml volume expansion induced a ≥2 mmHg increase of central venous pressure, suggesting a change in cardiac preload, in 40 patients, but none of the 28 of 40 nonresponders responded to an additional 200-ml volume expansion. Conclusions: During protective mechanical ventilation for early ARDS, partly because of insufficient changes in pleural pressure, Δ RESP PP performance was poor. Careful fluid challenges may be a safe alternative.
To determine predictors of mortality in the intensive care unit (ICU) and at 6 months after disch... more To determine predictors of mortality in the intensive care unit (ICU) and at 6 months after discharge; to assess the lifestyles of survivors 6 months after discharge. Prospective cohort study of patients screened upon admission and 6 months after discharge from the ICU. The ICU of a university hospital. One hundred sixteen consecutive patients age 70 and older admitted to the ICU and treated by mechanical ventilation for at least 24 hours. A comprehensive medical, functional, nutritional, and social assessment was undertaken for each patient upon admission to the ICU. Functional status and residence were recorded for patients still living 6 months after discharge from the ICU. Mortality in the ICU and 6 months after discharge was 31% and 52%, respectively. The predictors of in-ICU mortality on multivariate analysis were a high omega score per day in the ICU and a high simplified acute physiologic score corrected for points related to age (SAPS IIc). The predictors of mortality at 6 months were a high omega score per day in the ICU, a high SAPS IIc, and a mid-arm circumference (MAC) under the 10th percentile for the older French population in good health. Six months after discharge from the ICU, 91% of the surviving patients had the same residential status and 89% had a similar or improved functional status compared with pre-admission status. Although severity of illness remains an important predictor of in-ICU mortality and mortality at 6 months after release from ICU, we found that impaired nutritional status upon admission was related to 6-month mortality. These results emphasize the need for a systematic nutritional assessment in older patients admitted to the ICU and treated by mechanical ventilation.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2015
Background: Meta-analyses of nonrandomized studies have provided conflicting data on therapeutic ... more Background: Meta-analyses of nonrandomized studies have provided conflicting data on therapeutic hypothermia, or targeted temperature management (TTM), at 33°C in patients successfully resuscitated after nonshockable cardiac arrest. Nevertheless, the latest recommendations issued by the International Liaison Committee on Resuscitation and by the European Resuscitation Council recommend therapeutic hypothermia. New data are available on the adverse effects of therapeutic hypothermia, notably infectious complications. The risk/benefit ratio of therapeutic hypothermia after nonshockable cardiac arrest is unclear.
Intensive Care Medicine, 2014
La Presse Médicale, 2006
■ Summary Acute respiratory failure and septic shock induced by Mycobacterium bovis A rare side e... more ■ Summary Acute respiratory failure and septic shock induced by Mycobacterium bovis A rare side effect of intravesical BCG therapy Introduction > Intravesical bacillus Calmette-Guerin (BCG) therapy, recommended for superficial bladder tumors, triggers side effects in fewer than 5% of patients. The most severe side effects, however, are septic shock and acute respiratory failure. Case > A 70-year-old man was hospitalized for septic shock with acute respiratory and renal failure after intravesical instillation of BCG, which was identified in the gastric aspiration sample. Treatment with rifampicin, ethambutol, isoniazid, and corticosteroid therapy, as well as standard reanimation measures, led to the patient's recovery. Discussion > This case shows the potentially severe side effects of intravesical BCG instillation. Although this treatment is well tolerated in more than 95% of patients and its systemic complications can be effectively treated, these side effects can be life-threatening. Rival G, Garot D, Mercier E, Narciso B, Legras A, Perrotin D et al. Atteinte respiratoire sévère et choc septique à Mycobacterium bovis. Une complication rare de la BCG thérapie intravésicale.
Critical Care, 2014
In septic shock patients, the prevalence of low (<70%) central venous oxygen saturation (ScvO2) o... more In septic shock patients, the prevalence of low (<70%) central venous oxygen saturation (ScvO2) on admission to the intensive care unit (ICU) and its relationship to outcome are unknown. The objectives of the present study were to estimate the prevalence of low ScvO2 in the first hours of ICU admission and to assess its potential association with mortality in patients with severe sepsis or septic shock. Methods: This was a prospective, multicentre, observational study conducted over a one-year period in ten French ICUs. Clinicians were asked to include patients with severe sepsis or septic shock preferably within 6 hours of ICU admission and as soon as possible without changing routine practice. ScvO2 was measured at inclusion and 6 hours later (H6), by blood sampling.
Journal of Critical Care, 2009
Data regarding outcome of patients with chronic liver disease with severe hepatic encephalopathy ... more Data regarding outcome of patients with chronic liver disease with severe hepatic encephalopathy in intensive care unit are currently scarce. This study is a retrospective observational case series in a medical intensive care unit (ICU) in a university hospital from 1995 to 2005. Patients with hepatic encephalopathy (HE) (admitted with or developing) were identified. Clinical and laboratory parameters were analyzed to determinate predictors of ICU and 1-year mortality. Seventy-one patients were included (53 male). Median Simplified Acute Physiology Score was 56 with Child-Pugh score 11 +/- 2. Seventy-six percent of patients were admitted with coma (Glasgow Coma Scale, 7.7 +/- 4). Eighty-two percent of patients required intubation, and 28% vasopressors. Thirty-five percent died during ICU stay. At 1 year, mortality was 54%. Univariate analysis identified arterial hypotension, mechanical ventilation, vasopressors at any time, acute renal failure, Simplified Acute Physiology Score, and sepsis associated with ICU mortality. In multivariate analysis, vasopressor use or acute renal failure was the main independent predictor of ICU death and 1-year mortality. Patients free of these risk factors, even requiring intubation, were identified as isolated HE, with lower mortality rates. Predictors of outcome were similar to other groups of patients with liver disease admitted for other reasons. Intensive care unit mortality was lower than reported for other groups of patients with similar illness. Patients with severe HE admitted to ICU with no organ dysfunction other than mechanical ventilation had a better outcome and may require ICU admission.
Journal of Aerosol Medicine and Pulmonary Drug Delivery, 2009
The fraction of inspired oxygen (FiO 2 ) during oxygen-driven jet nebulization is unknown. In the... more The fraction of inspired oxygen (FiO 2 ) during oxygen-driven jet nebulization is unknown. In the case of air-driven jet nebulization, oxygen is often added through a nasal device, and again, the FiO 2 is unknown. The aim of this experimental study was to measure FiO 2 during oxygen-and air-driven jet nebulization, oxygen being added through a nasal device, and to compare the values observed with those measured during standard oxygen therapy. Methods: An endotracheal tube was inserted into the distal tracheal extremity of a cadaveric head and neck specimen and connected to a pump, simulating different respiratory patterns. FiO 2 was measured using an electrochemical oxygen analyzer under different nebulization and oxygen delivery conditions. Variables were compared using canonical analysis and analysis of simple and multiple variance. Results: FiO 2 was significantly influenced by the mode of oxygen delivery (p ϭ 0.001). The highest FiO 2 was observed when oxygen was delivered via a nasopharyngeal catheter associated with air-driven jet nebulization. For oxygen flow rates of 12 and 15 L/min, a nasal cannula combined with air-driven jet nebulization resulted in a similar FiO 2 . The FiO 2 was significantly lower in the case of oxygen-driven jet nebulization. The FiO 2 decreased with increasing respiratory rate (p Ͻ 0.001) and tidal volume (p Ͻ 0.001). Conclusions: Oxygen delivery through a nasal device during air-driven jet nebulization significantly increases the FiO 2 , whereas oxygen-driven jet nebulization dramatically decreases FiO 2 compared with standard oxygen therapy.
Journal of Aerosol Medicine, 1997
Page 1. JOURNAL OF AEROSOL MEDICINE Volume 10, Number 3, 1997 Mary Ann Liebert, Inc. Pp. 221-230 ... more Page 1. JOURNAL OF AEROSOL MEDICINE Volume 10, Number 3, 1997 Mary Ann Liebert, Inc. Pp. 221-230 Characterization on the Bench of an Amikacin Aerosol Before Clinical Studies PIERRE-FRANÇOIS DEQUIN,1 FRÉDÉRIQUE ...
Intensive Care Medicine, 2010
Objective: To determine the incidence, risk factors, severity, and preventability of iatrogenic e... more Objective: To determine the incidence, risk factors, severity, and preventability of iatrogenic events (IEs) as a cause of intensive care unit (ICU) admission. Design: Comparison of patients admitted or not for IE. IE was diagnosed after assessing independently predefined criteria. Setting: The ICU of a teaching hospital. Patients: All patients consecutively admitted over 6 months. Interventions: None. Measurements and results: Characteristics of patients, supportive treatments, length of stay, and outcomes were recorded. For patients admitted for IE, cause, origin, and preventability of IE were assessed by consensus. Of 528 patients, 103 (19.5%) were admitted for IE. Their Simplified Acute Physiology Score (SAPS) II was higher (41.2 ± 22.6 versus 31.4 ± 18.6), as was their Logistic Organ Dysfunction (LOD) score. Surgical admissions and admission for shock were more frequent. The main risk factors were age, underlying disease, low Mac Cabe or Knaus score, number of physicians treating the patient, number of drugs prescribed, and other hospitalization within 1 month. Length of stay was higher (11.1 days versus 7.9 days, 0.5-6.0, p = 0.02). Catecholamine drugs, blood transfusion, and parenteral nutrition were more frequently required in the IE group. ICU mortality was 15.5% in the IE group and 11.3% in the group without IEs [not significant (ns) after adjustment]. IE was considered as probably preventable in 73.8% of cases. Conclusion: Of admissions to the ICU, 19.5% resulted from IE, with high proportion of shock, leading to greater need for invasive treatments and longer stay in the ICU. Most cases of IE seemed preventable.
Critical Care, 2011
Introduction: Fluid responsiveness prediction is of utmost interest during acute respiratory dist... more Introduction: Fluid responsiveness prediction is of utmost interest during acute respiratory distress syndrome (ARDS), but the performance of respiratory pulse pressure variation (Δ RESP PP) has scarcely been reported. In patients with ARDS, the pathophysiology of Δ RESP PP may differ from that of healthy lungs because of low tidal volume (Vt), high respiratory rate, decreased lung and sometimes chest wall compliance, which increase alveolar and/or pleural pressure. We aimed to assess Δ RESP PP in a large ARDS population. Methods: Our study population of nonarrhythmic ARDS patients without inspiratory effort were considered responders if their cardiac output increased by >10% after 500-ml volume expansion. Results: Among the 65 included patients (26 responders), the area under the receiver-operating curve (AUC) for Δ RESP PP was 0.75 (95% confidence interval (CI 95 ): 0.62 to 0.85), and a best cutoff of 5% yielded positive and negative likelihood ratios of 4.8 (CI 95 : 3.6 to 6.2) and 0.32 (CI 95 : 0.1 to 0.8), respectively. Adjusting Δ RESP PP for Vt, airway driving pressure or respiratory variations in pulmonary artery occlusion pressure (ΔPAOP), a surrogate for pleural pressure variations, in 33 Swan-Ganz catheter carriers did not markedly improve its predictive performance. In patients with ΔPAOP above its median value (4 mmHg), AUC for Δ RESP PP was 1 (CI 95 : 0.73 to 1) as compared with 0.79 (CI 95 : 0.52 to 0.94) otherwise (P = 0.07). A 300-ml volume expansion induced a ≥2 mmHg increase of central venous pressure, suggesting a change in cardiac preload, in 40 patients, but none of the 28 of 40 nonresponders responded to an additional 200-ml volume expansion. Conclusions: During protective mechanical ventilation for early ARDS, partly because of insufficient changes in pleural pressure, Δ RESP PP performance was poor. Careful fluid challenges may be a safe alternative.
Critical Care, 2011
AKI, acute kidney injury; FG, fi ltration gradient; IAP, intra-abdominal pressure; MAP, mean arte... more AKI, acute kidney injury; FG, fi ltration gradient; IAP, intra-abdominal pressure; MAP, mean arterial pressure.
Clinical Toxicology, 1996
To describe fatal herbicide poisoning with Radoxone TL composed of aminotriazole and ammonium thi... more To describe fatal herbicide poisoning with Radoxone TL composed of aminotriazole and ammonium thiocyanate. A 54-year-old man was hospitalized because of unexplained coma with myoclonic jerks and vascular collapse. Despite symptomatic treatment with mechanical ventilation and vascular filling, life-threatening shock occurred with oliguria, profound metabolic acidosis and cardiac arrest. Hyperchloremia (141 mmol/L) with reversed anion gap (-19) suggested interference with chloride measurement caused by halogens (Br,F,I) or other anions such as thiocyanate. Eventually a weed killer, Radoxone TL containing ammonium thiocyanate, was found at the patient's house. Thiocyanate and aminotriazole blood levels were 750 mg/L and 138 mg/L respectively more than 12 hours after ingestion. After prolonged cardiopulmonary resuscitation, continuous venovenous hemodiafiltration was performed. Despite hemodynamic recovery the patient died 48 hours later of postanoxic coma. Aminotriazole, a systemic nonselective herbicide, is often associated with ammonium thiocyanate which enhances its activity. Experimental studies and previous fatal cases suggest a predominant toxicity of thiocyanate. Early diagnosis is important.
Anesthesia & Analgesia, 2009
Arterial cannulation is strongly recommended during shock. Nevertheless, this procedure is associ... more Arterial cannulation is strongly recommended during shock. Nevertheless, this procedure is associated with significant risks and may delay other emergent procedures. We assessed the discriminative power of brachial cuff oscillometric noninvasive blood pressure (NIBP) for identifying patients with an invasive mean arterial blood pressure (MAP) below 65 mm Hg or increasing their invasive MAP after cardiovascular interventions. This prospective study, conducted in three intensive care units, included adults in circulatory failure who underwent 45 degrees passive leg raising, 300 mL fluid loading, and additional 200 mL fluid loading. The collected data were four invasive and noninvasive MAP measurements at each study phase. Among 111 patients (50 septic, 15 cardiogenic, and 46 other source of shock), when averaging measurements of each study phase, NIBP measurements accurately predicted an invasive MAP lower than 65 mm Hg: area under the receiver operating characteristic curve 0.90 (95% CI: 0.71-1), positive and negative likelihood ratios 7.7 (95% CI: 5.4-11) and 0.31 (95% CI: 0.22-0.44) (cutoff 65 mm Hg). For identifying patients increasing their invasive MAP by more than 10%, the area under the receiver operating characteristic curve was 0.95 (95% CI: 0.92-0.96); positive and negative likelihood ratios (cutoff 10%) were 25.7 (95% CI: 10.8-61.4) and 0.26 (95% CI: 0.2-0.34). NIBP measurements have a good discriminative power for identifying hypotensive patients and performed even better in tracking MAP changes, provided that one averages four NIBP measurements.
Annales Françaises d'Anesthésie et de Réanimation, 2013