P Pronnier

Hôpital Albert Calmette

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Thierry Onimus

Centre Hospitalier Universitaire de Lille

Alain Durocher

Health and Education Research Management and Epidemiologic Services (United States)

Christophe Di Pompéo

Université de Lille

Saad Nseir

Centre Hospitalier Universitaire de Lille

F. Saulnier

Université de Lille

Bruno Grandbastien

University of Lausanne

M. Roussel‐Delvallez

Hôpital d'Instruction des Armées Bégin

Daniel Mathieu

Centre Hospitalier Universitaire de Lille

Stéphane Soubrier

Centre Hospitalier Universitaire de Lille

Sébastien Beague

Calmette Hospital

Cooperative Institutions

Université de Lille

Centre Hospitalier Universitaire de Lille

Hôpital Albert Calmette

Hôpital Roger Salengro

Calmette Hospital

Université Lille Nord de France

Inserm

Centre National de la Recherche Scientifique

Centre Hospitalier de Tourcoing

Santé Publique France

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Critical Care (2003)

Saad Nseir Christophe Di Pompéo Stéphane Soubrier P Pronnier Thierry Onimus

Studies on head injury-induced pituitary dysfunction are limited in number and conflicting results have been reported.To further clarify this issue, 29 consecutive patients (24 males), with severe (n = 21) or moderate (n = 8) head trauma, having a mean age of 37 ± 17 years were investigated in the immediate post-trauma period.All patients required mechanical ventilatory support for 8-55 days and were enrolled in the study within a few days before ICU discharge.Basal hormonal assessment included measurement of cortisol, corticotropin, free thyroxine (fT4), thyrotropin (TSH), testosterone (T) in men, estradiol (E2) in women, prolactin (PRL), and growth hormone (GH).Cortisol and GH levels were measured also after stimulation with 100 µg human corticotropin releasing hormone (hCRH) and 100 µg growth hormone releasing hormone (GHRH), respectively.Cortisol hyporesponsiveness was considered when peak cortisol concentration was less than 20 µg/dl following hCRH.TSH deficiency was diagnosed when a subnormal serum fT4 level was associated with a normal or low TSH.Hypogonadism was considered when T (males) or E2 (women) were below the local reference ranges, in the presence of normal PRL levels.Severe or partial GH deficiencies were defined as a peak GH below 3 µg/l or between 3 and 5 µg/l, respectively, after stimulation with GHRH.Twenty-one subnormal responses were found in 15 of the 29 patients (52%) tested; seven (24%) had hypogonadism, seven (24%) had cortisol hyporesponsiveness, five (17%) had hypothyroidism, and two patients (7%) had partial GH deficiency.These preliminary results suggest that a certain degree of hypopituitarism occurs in more than 50% of patients with moderate or severe head injury in the immediate post-trauma period, with cortisol hyporesponsiveness and hypogonadism being most common.Further studies are required to elucidate the pathogenesis of these abnormalities and to investigate whether they affect long-term morbidity.

10.1186/cc2033

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Fatal streptococcal necrotizing fasciitis as a complication of axillary brachial plexus block

British Journal of Anaesthesia (2004)

Saad Nseir P Pronnier Stéphane Soubrier Thierry Onimus F. Saulnier

Discontinuation

Toxic shock syndrome

10.1093/bja/aeh065

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Citations (64)

Critical Care (2002)

Saad Nseir Christophe Di Pompéo P Pronnier Thierry Onimus Sébastien Beague

Purpose: To describe the epidemiology of the acute respiratory distress syndrome (ARDS) in a Brazilian ICU.Methods: This prospective observational, non-interventional study, included all consecutive patients with ARDS criteria [1] admitted in the ICU of a Brazilian tertiary hospital, between January 1997 and September 2001.Were collected in a prospective fashion the following variables: age, gender, APACHE II score at ICU admission and at ARDS diagnosis, cause of ARDS, presence of AIDS, cancer and immunosuppression, occurrence of barotrauma, performance of traqueostomy, mortality, duration of mechanical ventilation (MV), length of stay (LOS) in ICU and in hospital.The lung injury score (LIS) [2] was used to quantify the degree of pulmonary injury in the first week of ARDS.Results: There was 2182 patients (P) admitted in ICU during the study period, of whom 141 (6.46%) had ARDS criteria.Seventy-six (54%) were men, the mean age was 46 ± 18 years, APACHE II 18 ± 7 and 19 ± 7 at admission and at ARDS diagnosis, respectively.Septic shock accounted for 42% (60 P) of the ARDS causes, sepsis 22% (31 P), diffuse pulmonary infection 16% (23 P), aspiration pneumonia 11% (15 P), non-septic shock 5% (7 P) and others 4% (5 P).Ten percent (14 P) had AIDS, 30% (43 P) cancer and 25% (36 P) immunosuppression.All patients were mechanically ventilated with Tidal Volume between 4 and 8 ml/kg.Only 3.5% (5 P) had barotrauma and 10% (14 P) performed traqueostomy.Mortality rate was 79% in the ICU.The patients required 12 ± 10 days on MV, ranging from 1 to 55 days.The LOS in ICU and hospital was 14 ± 13 (1-69) days and 28 ± 32 (1-325) days, respectively.There was a time delay of 3.7 ± 4.5 days between admission in ICU and the onset of ARDS.The Murray score (mean ± SD) was 3.2 ± 0.4, 3 ± 0.5, 3 ± 0.5, 2.9 ± 0.6, 2.8 ± 0.7, 2.7 ± 0.7 and 2.6 ± 0.8 in the first 7 days, respectively.Conclusions: ARDS in our hospital has a similar incidence of reports in the USA and Europe.There was a higher mortality, which could be explained by a high incidence of infection causes of ARDS, mainly septic shock, and elevated combined occurrence of AIDS, cancer and immunosuppression, along the degree of LIS.The incidence of barotrauma was low, as a consequence of the current mechanical ventilation strategies.

10.1186/cc1804

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Nosocomial tracheobronchitis in mechanically ventilated patients: incidence, aetiology and outcome

European Respiratory Journal (2002)

Saad Nseir Christophe Di Pompéo P Pronnier Sébastien Beague Thierry Onimus

The aim of this study was to determine the incidence, the organisms responsible for and the impact on outcome of nosocomial tracheobronchitis (NTB) in the intensive care unit (ICU). This prospective observational cohort study was conducted in a 30-bed medical/surgical ICU over a period of 6.5 yrs. All patients ventilated for >48 h were eligible. Patients with nosocomial pneumonia (NP) without prior NTB were excluded. Patients with first episodes of NTB were compared with those without NTB by univariate analysis. The study diagnosed 201 (10.6%) cases of NTB. Pseudomonas aeruginosa was the most common bacteria. NP rates were similar in patients with NTB compared with patients without NTB. Even in the absence of subsequent NP, NTB was associated with a significantly higher length of ICU stay and duration of mechanical ventilation in both surgical and medical populations. Mortality rates were similar in NTB patients without subsequent NP compared with patients without NTB. Antimicrobial treatment in NTB patients was associated with a trend to a better outcome. Nosocomial tracheobronchitis is common in mechanically ventilated intensive care unit patients. In this population, nosocomial tracheobronchitis was associated with longer durations of intensive care unit stay and mechanical ventilation. Further studies are needed to determine the impact of antibiotics on outcomes of patients with nosocomial tracheobronchitis.

Ventilator-associated Pneumonia

Univariate analysis

Artificial ventilation

10.1183/09031936.02.00012902

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Citations (206)

[Early and late nosocomial broncho-pulmonary diseases in intensive care. Comparative study of risk factors and of causing bacteria].

PubMed (2003)

Saad Nseir Christophe Di Pompéo P Pronnier Stéphane Soubrier Thierry Onimus

Tracheotomy

Univariate analysis

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Effect of gingival and dental plaque antiseptic decontamination on nosocomial infections acquired in the intensive care unit: A double-blind placebo-controlled multicenter study*

Critical Care Medicine (2005)

François Fourrier Didier Dubois P Pronnier Patrick Herbecq O. Leroy

Objective: To document the effect of gingival and dental plaque antiseptic decontamination on the rate of nosocomial bacteremias and respiratory infections acquired in the intensive care unit (ICU). Design: Prospective, multicenter, double-blind, placebo-controlled efficacy study. Setting: Six ICUs: three in university hospitals and three in general hospitals. Patients: A total of 228 nonedentulous patients requiring endotracheal intubation and mechanical ventilation, with an anticipated length of stay ≥5 days. Interventions: Antiseptic decontamination of gingival and dental plaque with a 0.2% chlorhexidine gel or a placebo gel, three times a day, during the entire ICU stay. Measurements and Main Results: Demographic and clinical characteristics, organ function data (Logistic Organ Dysfunction score), severity of condition (Simplified Acute Physiologic Score), and dental plaque status were assessed at baseline and until 28 days. Bacteriologic sampling of dental plaque and saliva was done every 5 days, and blood, tracheal aspirate, and bronchoalveolar lavage cultures were performed when appropriate. The primary efficacy end point was the incidence of bacteremia, bronchitis, and ventilator-associated pneumonia, expressed as a percentage and per 1000 ICU days. All baseline characteristics were similar between the treated and the placebo groups. The incidence of nosocomial infections was 17.5% (13.2 per 1000 ICU days) in the placebo group and 18.4% (13.3 per 1000 ICU days) in the plaque antiseptic decontamination group (not significant). No difference was observed in the incidence of ventilator-associated pneumonia per ventilator or intubation days, mortality, length of stay, and care loads (secondary end points). On day 10, the number of positive dental plaque cultures was significantly lower in the treated group (29% vs. 66%; p < .05). Highly resistant Pseudomonas, Acinetobacter, and Enterobacter species identified in late-onset ventilator-associated pneumonia and previously cultured from dental plaque were not eradicated by the antiseptic decontamination. No side effect was reported. Conclusions: Gingival and dental plaque antiseptic decontamination significantly decreased the oropharyngeal colonization by aerobic pathogens in ventilated patients. However, its efficacy was insufficient to reduce the incidence of respiratory infections due to multiresistant bacteria.

Ventilator-associated Pneumonia

Antiseptic

Bacteremia

10.1097/01.ccm.0000171537.03493.b0

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Citations (272)

Complications infectieuses et cathéter périnerveux fémoral pour l’analgésie postopératoire : à propos de deux cas

Annales Françaises d Anesthésie et de Réanimation (2011)

Fleur Delfosse P Pronnier Tolga Levent M.-L. Coget K. Blanckaert

10.1016/j.annfar.2011.03.002

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Citations (3)

Infections broncho-pulmonaires nosocomiales précoces et tardives en réanimation

Saad Nseir Christophe Di Pompéo P Pronnier Stéphanie Soubrier Thierry Onimus

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