Jean-Yves Fagon

Assistance Publique – Hôpitaux de Paris

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Nadia Aïssaoui

Université Paris Cité

Emmanuel Guérot

Hôpital Européen Georges-Pompidou

Jean Chastre

Sorbonne Université

Benoı̂t Diébold

Hôpital Cochin

Pascal Leprince

Fondation pour l’innovation en Cadiométabolisme et Nutrition

Jan Gummert

Heart and Diabetes Center North Rhine-Westphalia

Michiel Morshuis

Heart and Diabetes Center North Rhine-Westphalia

Joe‐Elie Salem

Sorbonne Université

Jean‐Luc Diehl

Assistance Publique – Hôpitaux de Paris

Nadia Aïssaoui

Université Paris Cité

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Assistance Publique – Hôpitaux de Paris

Inserm

Université Paris Cité

Hôpital Européen Georges-Pompidou

Hôpital Européen

Sorbonne Université

Sorbonne Paris Cité

Pitié-Salpêtrière Hospital

Délégation Paris 5

Hôpital Bichat-Claude-Bernard

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Diagnosis and treatment of nosocomial pneumonia in ALI/ARDS patients

European Respiratory Journal (2003)

Jean-Yves Fagon Jean Chastre

Ventilator-associated pneumonia (VAP) is a common complication of the acute respiratory distress syndrome (ARDS) or acute lung injury (ALI), often leading to the development of sepsis, multiple organ failure, and death. However, the diagnosis of pulmonary infection in patients with ARDS/ALI is often difficult: the systemic signs of infection, such as fever, tachycardia, leukocytosis are nonspecific findings in such patients; a variety of causes other than pneumonia can explain asymmetric consolidation in patients with ARDS and marked asymmetry of radiographic abnormalities has also been reported in patients with uncomplicated ARDS. In 2003, physicians in charge of these patients have to identify patients with true bacterial lung infection, to select appropriate initial antibiotic therapy, to adjust therapy as soon as possible, and to withhold antibiotics in patients without VAP. To do that, a bacteriological strategy based on the use of quantitative cultures of specimen obtained with fibreoptic bronchoscopy performed before initiation or modification of antibiotic treatment seems better than a strategy based on clinical evaluation alone, lowering antibiotic consumption and improving outcome. When bronchoscopy is not available or contraindicated, a nonbronchoscopic strategy or a clinical strategy with re-evaluation 3 days after initiation of treatment may be used. Antimicrobial treatment of VAP is a complex issue. Some general principles can be helpful for the selection of initial treatment: knowledge of most frequently identified responsible pathogens and their susceptibility patterns in the unit; prior duration of hospitalisation; previously prescribed antibiotics; information obtained by direct examination of pulmonary secretions; antibacterial activity and pharmacodynamic characteristics of antibiotics that could be used to treat this infection. Appropriateness of initial antimicrobial therapy is probably a major prognostic factor for patients with ventilator-associated pneumonia. Thus, before new antiboitics are administered, reliable pulmonary specimens must be obtained for direct examination and cultures.

Ventilator-associated Pneumonia

10.1183/09031936.03.00421203

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Citations (25)

Noninvasive positive pressure ventilation in acute respiratory failure: report of an International Consensus Conference in intensive care medicine, Paris, France, 13–14 April 2000,

Réanimation (2001)

Tamara S. Evans Richard Albert Derek C. Angus Julian Bion Jean‐Daniel Chiche

T.W. Evans**, R.K. Albert, D.C. Angus, J.F. Bion, J.D. Chiche, S.K. Epstein, J.Y. Fagon, M. Ranieri, J.I. Sznajder, A. Torres, K.R. Walley 1 Royal Brompton Hospital, Sydney Street, London SW6 3NP, United Kingdom ; 2 Denver, CO, USA ; 3 Pittsburgh, PA, USA ; 4 Birmingham, United Kingdom ; 5 Paris, France ; 6 Boston, MA, USA ; 7 Pisa, Italy ; 8 Chicago, IL, USA ; 9 Barcelona, Spain ; 10 Vancouver, Canada

Kingdom

Consensus conference

Acute respiratory failure

Respiratory Medicine

10.1016/s1164-6756(00)00087-6

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Citations (16)

High Prevalence of Respiratory Viral Infections in Patients Hospitalized in an Intensive Care Unit for Acute Respiratory Infections as Detected by Nucleic Acid-Based Assays

Journal of Clinical Microbiology (2005)

Jérôme LeGoff Emmanuel Guérot Angélique Ndjoyi‐Mbiguino Mathieu Matta Ali Si‐Mohamed

Forty-seven bronchoalveolar lavages (BAL) were obtained from 41 patients with acute pneumonia attending an intensive care unit. By molecular diagnosis, 30% of total BAL and 63% of bacteria-negative BAL were positive for respiratory viruses. Molecular detection allows for high-rate detection of respiratory viral infections in adult patients suffering from severe pneumonia.

10.1128/jcm.43.1.455-457.2005

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Outcomes in elderly patients admitted to the intensive care unit with solid tumors

Annals of Intensive Care (2017)

Édouard Auclin Anaïs Charles‐Nelson Baptiste Abbar Emmanuel Guérot Stéphane Oudard

As the population ages and cancer therapies improve, there is an increased call for elderly cancer patients to be admitted to the intensive care unit (ICU). This study aimed to assess short-term survival and prognostic factors in critically ill patients with solid tumors aged ≥65 years. We conducted a retrospective study. The primary endpoint was ICU mortality. Resumption of anticancer therapy in patients who survived the ICU stay and 90-day mortality were secondary endpoints. All patients aged ≥65 years admitted to the ICU of Georges Pompidou Hospital (Paris, France) between 2009 and 2014 were eligible. Of 2327 eligible elderly patients (EP), 262 (75.0 ± 6.7 years) with solid tumors were analyzed. These patients were extremely critically ill (SAPS 2 61.9 ± 22.5), and 60.3% had metastatic disease. Gastrointestinal, lung and genitourinary cancers were the most common types of tumors. Mechanical ventilation was required in 51.5% of patients, inotropes in 48.1% and dialysis in 12.6%. Most patients (66.7%) were admitted for reasons unrelated to cancer, including sepsis (30.5%), acute respiratory failure (28.2%) and neurological problems (8.0%). ICU mortality in patients with cancer was 33.6 versus 32.6% among patients without cancer (p = 0.75). Among the cancer EP, the 90-day mortality was 51.9% (n = 136). In multivariate analysis, increased SAPS 2 score and primary tumor site were associated with 90-day death, whereas previous anticancer therapies and poor performance status were not. Among survivor patients from ICU with anti-tumoral treatment indication, 77 (52.7%) had resumption of anticancer treatment. Elderly solid tumor patients admitted to the ICU had a mortality rate similar to EP without cancer. Prognostic factors for 90-day mortality were more related to severity of clinical status at admission than the presence or stage of cancer, suggesting that early admission of EP with cancer to the ICU is appropriate.

SAPS II

Clinical endpoint

10.1186/s13613-017-0250-0

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Citations (46)

Evaluation De La Compliance Vasculaire Totale Des Malades Porteurs d'Un Sepsis En Reanimation

Annales Françaises d Anesthésie et de Réanimation (1995)

François Stéphan B. Tournler Ana Novara J.M. Malllet Michel Safar

10.1016/s0750-7658(05)81050-0

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Impact of Inodilator Drugs on Echocardiographic Assessments of Left Ventricular Filling Pressure in Patients With Decompensated End-Stage Heart Failure*

Critical Care Medicine (2014)

Joe‐Elie Salem Nadia Aïssaoui Lech Paluszkiewicz Michiel Morshuis Jan Gummert

We investigated the impact of inodilators on the accuracy of E/e' ratio as a surrogate for pulmonary artery occlusion pressure in patients with decompensated end-stage systolic heart failure.The ratio of early diastolic transmitral flow velocity to tissue Doppler mitral annular early diastolic velocity, E/e', and pulmonary artery occlusion pressure have been shown to be correlated. The validity of E/e' for predicting pulmonary artery occlusion pressure in patients with decompensated end-stage systolic heart failure was recently challenged, but the influence of inodilators was not taken into account, despite the reported influence of these drugs on left ventricular relaxation properties.Invasive hemodynamic monitoring and echocardiographic data were collected prospectively from 39 patients with decompensated end-stage systolic heart failure (92% male), aged 56 ± 13 years. These patients had dilated ventricles with a low cardiac index (1.9 ± 0.6 L/min/m) and high pulmonary artery occlusion pressure (22 ± 8 mm Hg), and 90% required inodilator support during hospitalization.The correlation between septal E/e' and pulmonary artery occlusion pressure was good for examinations in the absence of inodilators (n = 21) (r = 0.7; p < 0.001), but no correlation was found when inodilators were used (n = 31). Lateral and mean E/e' were poorly correlated with pulmonary artery occlusion pressure, if at all, in both cases.By modifying ventricular relaxation properties and the influence of filling pressure on e', inodilator agents severely impair the correlation between E/e' and pulmonary artery occlusion pressure in patients with decompensated end-stage systolic heart failure.

10.1097/ccm.0000000000000513

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Citations (10)

Infections inhabituelles

Réanimation (2011)

Jérôme Le Goff Charles‐Édouard Luyt Florence Bellenfant Rachid Kara Jean Chastre

Infections inhabituellesUnusual infections SO096 Y a-t-il une place pour la corticothérapie dans le traitement des leptospiroses graves ?(Étude randomisée en double insu) Is there a place for corticosteroids in the treatment of severe leptospirosis?(Randomized double-blind study) H. Sbai anesthésie réanimation a4, CHU Hassan ii, Fès, Maroc Introduction : la leptospirose est une zoonose causée par des spirochètes du genre leptospira.Il a été récemment prouvé que la gravité de cette affection est essentiellement attribuée au développement d'une réaction inflammatoire -de type humorale -virulente entre le spirochète et l'hôte.Objectif : Déterminer l'impact d'une corticothérapie à dose immunosuppressive sur l'évolution clinique et biologique des formes graves de leptospirose.Patients et méthodes : Étude randomisée en double aveugle effectuée chez tous les patients admis au CHU Hassan II pour lepto spirose grave depuis juillet 2010.Un groupe a reçu un traitement à base de méthyl-prednisolone, 1 g par voie intraveineuse, pendant les trois premiers jours de son hospitalisation, tandis que le second groupe a reçu un placebo à base de 10 ml de sérum physiologique pendant 3 jours.l'accord éclairé de tous les patients a été obtenu.les données cliniques, radiologiques, biologiques, thérapeutiques et évolutives des deux groupes ont été comparées et analysées par le logiciel ÉpiInfo ® .Résultats : Cinquante et un cas ont été inclus dans cette étude.Vingt-cinq patients ont reçu un traitement corticoïde (groupe a) et 26 ayant reçu un placebo (groupe B). le sex-ratio était de 22 hommes/ 3 femmes pour le groupe a versus 24 hommes/2 femmes pour le groupe B. l'âge moyen était de 35 ans (31 ans dans le groupe a et 39 ans dans le groupe B). le délai d'admission moyen était de 7 jours (2-15 jours).le score IGS II était de 34 dans le groupe a vs 39 dans le groupe B. la durée moyenne d'hospitalisation était de 7 jours pour le groupe a vs dix jours pour le groupe B. la durée de rémission chez les survivants des deux groupes était identique.l'atteinte respiratoire était observée dans 57 % dans le groupe a vs 52 % dans le groupe B. le recours à la ventilation artificielle était nécessaire dans 35 % des cas dans le groupe a vs 70 % dans le groupe B. Une pneumopathie acquise sous ventilation artificielle a été observée dans 17 % pour le groupe a vs 65 % pour le groupe B. l'insuffisance rénale était observée chez tous les patients.l'hémodialyse était nécessaire dans 45 % des cas dans le groupe B vs 10 % dans le groupe a. l'usage des drogues vasoinotropes était nécessaire dans 45 % dans le groupe a vs 78 % dans le groupe B. la thrombopénie était en moyenne à 45 000 ± 11 000/mm 3 dans le groupe a vs 52 000 ± 14 000/mm 3 dans le groupe B. la mortalité dans le groupe a était de 11 contre 39 % dans le groupe B.

10.1007/s13546-011-0366-4

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Citations (0)

Is the Thoratec® paracorporeal ventricular assist device a primary or secondary device to support patients with refractory cardiogenic shock?

Archives of cardiovascular diseases (2009)

Nadia Aïssaoui Benoı̂t Diébold Jean-Yves Fagon Pascal Leprince

Refractory (planetary science)

10.1016/j.acvd.2009.06.001

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Citations (1)

Assessment of five screening strategies for optimal detection of carriers of third-generation cephalosporin-resistant Enterobacteriaceae in intensive care units using daily sampling

Clinical Microbiology and Infection (2014)