5 research outputs found
Epidémiologie et facteurs pronostiques des pneumonies aiguës communautaires en réanimation
LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF
Can we improve transthoracic echocardiography training in non-cardiologist residents? Experience of two training programs in the intensive care unit
International audienceBackgroundTo evaluate the diagnostic performances of two training programs for residents with no prior ultrasound experience to reach competences in extended basic critical care transthoracic echocardiography (CCE) including Doppler capabilities.MethodsThis is a prospective observational study in two intensive care units of teaching hospitals. Group I (five residents) completed a short training program (4-h theory; 3-h practical); group II (six residents) completed a longer training program (6-h theory; 12-h practical). The residents and an expert examined all patients who required a transthoracic echocardiography. Their agreement studied by Cohenâs Îș coefficient, concordance coefficient correlation (CCC) and BlandâAltman plots was used as an indicator of program effectiveness.ResultsGroup I performed 136 CCEs (mean/resident 27; range 22â32; 65 in ventilated patients) in 115 patients (62 men; 64 ± 18 years; Simplified Acute Physiologic Score [SAPS] II 37 ± 18). Group II performed 158 CCEs (mean/resident 26; range 21â31; 65 in ventilated patients) in 108 patients (64 men; 58 ± 17 years; SAPS II 42 ± 22). Both groups adequately assessed left ventricular (LV) systolic function (Îș 0.75, 95 % confidence interval [CI] 0.64â0.86; Îș 0.77, 95 % CI 0.66â0.88, respectively) and pericardial effusion (Îș 0.83, 95 % CI 0.67â0.99; Îș 0.76, 95 % CI 0.60â0.93, respectively). Group II appraised severe right ventricular dilatation and significant left-sided valve disease with good to very good agreement (Îș 0.80, 95 % CI 0.56â0.96; Îș 0.79, 95 % CI 0.66â0.93, respectively). Regarding left ventricular ejection fraction, E/A ratio, E/eâČ ratio and aortic peak velocity assessed by group II, CCCs were all >0.70 and the bias (mean difference) ±SD on BlandâAltman analysis was 1.3 ± 8.8 %, 0 ± 0.3, 0.4 ± 2.2 and 0.1 ± 0.4 m/s, respectively. Detection of paradoxical septum (Îș 0.65, 95 % CI 0.37â0.93), of heterogeneous LV contraction (Îș 0.49, 95 % CI 0.33â0.65) and of respiratory variation of the inferior vena cava (Îș 0.27, 95 % CI 0.09â0.45), as well as stroke volume measurement (CCC 0.65, 95 % CI 0.54â0.74; bias ± SD â1.4 ± 4.7 cm), was appraised by group II with moderate agreement requiring probably more comprehensive training.ConclusionsAlthough a training program blending 6-h theory and 12-h practical may be adapted to achieve some essential competences, it seems to be insufficiently to perform a complete extended basic critical care transthoracic echocardiography including Doppler capabilities
Le ComitĂ© dâĂ©thique de la recherche en anesthĂ©sie-rĂ©animation (CERAR) de la SFAR
International audienceLe but de la recherche en mĂ©decine est dâamĂ©liorer les connaissances sur lesquelles reposent les pratiques de soin. Elle porte sur les mĂ©canismes et les causes des maladies, lâĂ©pidĂ©miologie et les pratiques diagnostiques et thĂ©rapeutiques. Pour ce faire, elle peut utiliser lâanalyse de donnĂ©es existantes ou bien recourir Ă des interventions. La publication de ses rĂ©sultats permet Ă lâensemble des soignants et des patients dâen bĂ©nĂ©ficier.Dans ce contexte et compte tenu du grand nombre de projets RNIPH en anesthĂ©sie-rĂ©animation, la SFAR sâest dotĂ©e dâun CER dĂ©diĂ© Ă la spĂ©cialitĂ© afin de fournir un avis Ă©thique en vue de publication pour les Ă©tudes non interventionnelles en anesthĂ©sie-rĂ©animation et mĂ©decine pĂ©riopĂ©ratoire ne relevant pas des CPP.Ăvaluer les Ă©tudes cliniques venant de toute la communautĂ© de lâanesthĂ©sie-rĂ©animation française et participer au dynamisme de la spĂ©cialitĂ© en permettant dâamĂ©liorer les connaissances et les pratiques est une tĂąche que le CERAR accomplit avec plaisir et fiertĂ©, et quâil souhaite pĂ©renniser afin dâapporter sa contribution Ă cette dĂ©marche dâintĂ©rĂȘt collectif.Notre ambition pour le futur est dâenrichir sans cesse notre expĂ©rience des projets Ă©valuĂ©s pour affiner notre rĂ©flexion et la partage
Efficacy and safety of baricitinib in hospitalized adults with severe or critical COVID-19 (Bari-SolidAct): a randomised, double-blind, placebo-controlled phase 3 trial
International audienceAbstract Background Baricitinib has shown efficacy in hospitalized patients with COVID-19, but no placebo-controlled trials have focused specifically on severe/critical COVID, including vaccinated participants. Methods Bari-SolidAct is a phase-3, multicentre, randomised, double-blind, placebo-controlled trial, enrolling participants from June 3, 2021 to March 7, 2022, stopped prematurely for external evidence. Patients with severe/critical COVID-19 were randomised to Baricitinib 4 mg once daily or placebo, added to standard of care. The primary endpoint was all-cause mortality within 60 days. Participants were remotely followed to day 90 for safety and patient related outcome measures. Results Two hundred ninety-nine patients were screened, 284 randomised, and 275 received study drug or placebo and were included in the modified intent-to-treat analyses (139 receiving baricitinib and 136 placebo). Median age was 60 (IQR 49â69) years, 77% were male and 35% had received at least one dose of SARS-CoV2 vaccine. There were 21 deaths at day 60 in each group, 15.1% in the baricitinib group and 15.4% in the placebo group (adjusted absolute difference and 95% CI ââ0.1% [ââ8·3 to 8·0]). In sensitivity analysis censoring observations after drug discontinuation or rescue therapy (tocilizumab/increased steroid dose), proportions of death were 5.8% versus 8.8% (ââ3.2% [ââ9.0 to 2.7]), respectively. There were 148 serious adverse events in 46 participants (33.1%) receiving baricitinib and 155 in 51 participants (37.5%) receiving placebo. In subgroup analyses, there was a potential interaction between vaccination status and treatment allocation on 60-day mortality. In a subsequent post hoc analysis there was a significant interaction between vaccination status and treatment allocation on the occurrence of serious adverse events, with more respiratory complications and severe infections in vaccinated participants treated with baricitinib. Vaccinated participants were on average 11 years older, with more comorbidities. Conclusion This clinical trial was prematurely stopped for external evidence and therefore underpowered to conclude on a potential survival benefit of baricitinib in severe/critical COVID-19. We observed a possible safety signal in vaccinated participants, who were older with more comorbidities. Although based on a post-hoc analysis, these findings warrant further investigation in other trials and real-world studies. Trial registration Bari-SolidAct is registered at NCT04891133 (registered May 18, 2021) and EUClinicalTrials.eu ( 2022-500385-99-00 )