39 research outputs found
Hemodynamic Changes during a Deep Inspiration Maneuver Predict Fluid Responsiveness in Spontaneously Breathing Patients
Objective. We hypothesized that the hemodynamic response to a deep inspiration maneuver (DIM) indicates fluid responsiveness in spontaneously breathing (SB) patients. Design. Prospective study. Setting. ICU of a general hospital. Patients. Consecutive nonintubated patients without mechanical ventilation, considered for volume expansion (VE). Intervention. We assessed hemodynamic status at baseline and after VE. Measurements and Main Results. We measured radial pulse pressure (PP) using an arterial catheter and peak velocity of femoral artery flow (VF) using continuous Doppler. Changes in PP and VF induced by a DIM (ÎPPdim and ÎVFdim) were calculated in 23 patients. ÎPPdim and ÎVFdim â„12% predicted responders to VE with sensitivity of 90% and specificity of 100%. Conclusions. In a restricted population of SB patients with severe sepsis or acute pancreatitis, ÎPPdim and ÎVFdim are accurate indices for predicting fluid responsiveness. These results should be confirmed in a larger population before validating their use in current practice
a planned ancillary analysis of the coVAPid cohort
Funding: This study was supported in part by a grant from the French government through the «Programme Investissement dâAvenir» (I-SITE ULNE) managed by the Agence Nationale de la Recherche (coVAPid project). The funders of the study had no role in the study design, data collection, analysis, or interpreta tion, writing of the report, or decision to submit for publication.BACKGROUND: Patients with SARS-CoV-2 infection are at higher risk for ventilator-associated pneumonia (VAP). No study has evaluated the relationship between VAP and mortality in this population, or compared this relationship between SARS-CoV-2 patients and other populations. The main objective of our study was to determine the relationship between VAP and mortality in SARS-CoV-2 patients. METHODS: Planned ancillary analysis of a multicenter retrospective European cohort. VAP was diagnosed using clinical, radiological and quantitative microbiological criteria. Univariable and multivariable marginal Cox's regression models, with cause-specific hazard for duration of mechanical ventilation and ICU stay, were used to compare outcomes between study groups. Extubation, and ICU discharge alive were considered as events of interest, and mortality as competing event. FINDINGS: Of 1576 included patients, 568 were SARS-CoV-2 pneumonia, 482 influenza pneumonia, and 526 no evidence of viral infection at ICU admission. VAP was associated with significantly higher risk for 28-day mortality in SARS-CoV-2 (adjusted HR 1.70 (95% CI 1.16-2.47), pâ=â0.006), and influenza groups (1.75 (1.03-3.02), pâ=â0.045), but not in the no viral infection group (1.07 (0.64-1.78), pâ=â0.79). VAP was associated with significantly longer duration of mechanical ventilation in the SARS-CoV-2 group, but not in the influenza or no viral infection groups. VAP was associated with significantly longer duration of ICU stay in the 3 study groups. No significant difference was found in heterogeneity of outcomes related to VAP between the 3 groups, suggesting that the impact of VAP on mortality was not different between study groups. INTERPRETATION: VAP was associated with significantly increased 28-day mortality rate in SARS-CoV-2 patients. However, SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, did not significantly modify the relationship between VAP and 28-day mortality. CLINICAL TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov, number NCT04359693.publishersversionpublishe
Implication du cytosquelette dans les dysfonctions myocardiques : exemple de la cardiomyopathie septique
The cytoskeleton is composed of intracellular microfilaments (actin polymers), microtubules (tubulin polymers) and intermediate filaments (desmin, lamin ⊠polymers).Sepsis, the association of an infection and a systemic inflammatory response, induces myocardial dysfunction. Septic cardiomyopathy appears in the early phase of sepsis and is associated with fatal outcome. Complete recovery of myocardial function occurs within two weeks following the onset of myocardial dysfunction in surviving patients. Although several studies demonstrate a role of cytoskeleton in septic cardiomyopathy, the involvement of microfilaments and microtubules is not clear.Macrophage migration inhibitory factor (MIF) is a pro-inflammatory cytokine secreted during sepsis that is suggested to postpone myocardium recovery. The first aim of the study was to characterize microtubule implications in MIF-induced cardiac muscle dysfunction. In a model of human right atrial trabecule we demonstrated that MIF induces microtubule stabilizations which are responsible for high intracellular viscosity, contractile and mitochondria dysfunctions. Our results suggest that MIF-induced microtubule stabilizations might be responsible for a delay of myocardial recovery during septic cardiomyopathy. The second aim of the study was to characterize microfilament involvements in a murine inflammatory cardiomyopathy induced by a lipopolysaccharid (LPS) injection. Our results suggest that microfilament stabilizations might be responsible for LPS-induced contractile and mitochondria dysfunctions in the early phase of inflammatory cardiomyopathy. Thus, these new fundamental mechanisms suggest a direct involvement of microtubules and microfilaments in the development and evolution of inflammatory cardiomyopathies.Le cytosquelette se compose de microfilaments (polymĂšres dâactine), de microtubules (polymĂšres de tubuline) et de filaments intermĂ©diaires (polymĂšres de desmine, de lamines âŠ). Le sepsis dĂ©fini par une infection associĂ©e Ă une rĂ©action inflammatoire systĂ©mique est responsable de dysfonctions myocardiques de mauvais pronostique. Cette cardiomyopathie apparait dans les premiĂšres heures du sepsis et guĂ©rit en moins de deux semaines chez les survivants. MĂȘme si certaines Ă©tudes dĂ©montrent lâimplication dâĂ©lĂ©ments du cytosquelette dans la cardiomyopathie septique, les rĂŽles des microfilaments et des microtubules ne sont pas clairement Ă©tablis.Macrophage migration inhibitory factor (MIF) est une cytokine pro-inflammatoire sĂ©crĂ©tĂ©e en excĂšs dans le sepsis qui serait responsable dâun ralentissement de la rĂ©cupĂ©ration myocardique. Dans un premier temps, notre travail a consistĂ© Ă caractĂ©riser lâimplication des microtubules dans la dysfonction musculaire cardiaque induite par MIF. Dans un modĂšle de trabĂ©cules auriculaires droites humaines nous avons dĂ©montrĂ© que MIF induit une hyperpolymĂ©risation des microtubules responsable dâune hyperviscositĂ© intracellulaire, dâune dysfonction mitochondriale et dâune dysfonction contractile. Nos rĂ©sultats suggĂšrent quâune hyperpolymĂ©risation des microtubules induite par MIF pourrait ĂȘtre responsable dâun ralentissement de la rĂ©cupĂ©ration myocardique Ă la phase tardive de la myocardiopathie septique. Dans un second temps, nous avons Ă©valuĂ© lâimplication des microfilaments dans un modĂšle murin de dysfonction myocardique inflammatoire induite par lâinjection dâune endotoxine bactĂ©rienne, le lipopolysaccharide. Nos rĂ©sultats suggĂšrent quâĂ la phase prĂ©coce de la cardiomyopathie inflammatoire il existe une hyperpolymĂ©risation des microfilaments responsable de dysfonctions contractile et mitochondriale.Les connaissances fondamentales acquises au cours de ce travail de thĂšse suggĂšrent une implication directe des microtubules et des microfilaments dans la physiopathologie des cardiomyopathies inflammatoires
Cytoskeleton involvement in myocardial dysfunctions : the example of the septic cardiomyopathy
Le cytosquelette se compose de microfilaments (polymĂšres dâactine), de microtubules (polymĂšres de tubuline) et de filaments intermĂ©diaires (polymĂšres de desmine, de lamines âŠ). Le sepsis dĂ©fini par une infection associĂ©e Ă une rĂ©action inflammatoire systĂ©mique est responsable de dysfonctions myocardiques de mauvais pronostique. Cette cardiomyopathie apparait dans les premiĂšres heures du sepsis et guĂ©rit en moins de deux semaines chez les survivants. MĂȘme si certaines Ă©tudes dĂ©montrent lâimplication dâĂ©lĂ©ments du cytosquelette dans la cardiomyopathie septique, les rĂŽles des microfilaments et des microtubules ne sont pas clairement Ă©tablis.Macrophage migration inhibitory factor (MIF) est une cytokine pro-inflammatoire sĂ©crĂ©tĂ©e en excĂšs dans le sepsis qui serait responsable dâun ralentissement de la rĂ©cupĂ©ration myocardique. Dans un premier temps, notre travail a consistĂ© Ă caractĂ©riser lâimplication des microtubules dans la dysfonction musculaire cardiaque induite par MIF. Dans un modĂšle de trabĂ©cules auriculaires droites humaines nous avons dĂ©montrĂ© que MIF induit une hyperpolymĂ©risation des microtubules responsable dâune hyperviscositĂ© intracellulaire, dâune dysfonction mitochondriale et dâune dysfonction contractile. Nos rĂ©sultats suggĂšrent quâune hyperpolymĂ©risation des microtubules induite par MIF pourrait ĂȘtre responsable dâun ralentissement de la rĂ©cupĂ©ration myocardique Ă la phase tardive de la myocardiopathie septique. Dans un second temps, nous avons Ă©valuĂ© lâimplication des microfilaments dans un modĂšle murin de dysfonction myocardique inflammatoire induite par lâinjection dâune endotoxine bactĂ©rienne, le lipopolysaccharide. Nos rĂ©sultats suggĂšrent quâĂ la phase prĂ©coce de la cardiomyopathie inflammatoire il existe une hyperpolymĂ©risation des microfilaments responsable de dysfonctions contractile et mitochondriale.Les connaissances fondamentales acquises au cours de ce travail de thĂšse suggĂšrent une implication directe des microtubules et des microfilaments dans la physiopathologie des cardiomyopathies inflammatoires.The cytoskeleton is composed of intracellular microfilaments (actin polymers), microtubules (tubulin polymers) and intermediate filaments (desmin, lamin ⊠polymers).Sepsis, the association of an infection and a systemic inflammatory response, induces myocardial dysfunction. Septic cardiomyopathy appears in the early phase of sepsis and is associated with fatal outcome. Complete recovery of myocardial function occurs within two weeks following the onset of myocardial dysfunction in surviving patients. Although several studies demonstrate a role of cytoskeleton in septic cardiomyopathy, the involvement of microfilaments and microtubules is not clear.Macrophage migration inhibitory factor (MIF) is a pro-inflammatory cytokine secreted during sepsis that is suggested to postpone myocardium recovery. The first aim of the study was to characterize microtubule implications in MIF-induced cardiac muscle dysfunction. In a model of human right atrial trabecule we demonstrated that MIF induces microtubule stabilizations which are responsible for high intracellular viscosity, contractile and mitochondria dysfunctions. Our results suggest that MIF-induced microtubule stabilizations might be responsible for a delay of myocardial recovery during septic cardiomyopathy. The second aim of the study was to characterize microfilament involvements in a murine inflammatory cardiomyopathy induced by a lipopolysaccharid (LPS) injection. Our results suggest that microfilament stabilizations might be responsible for LPS-induced contractile and mitochondria dysfunctions in the early phase of inflammatory cardiomyopathy. Thus, these new fundamental mechanisms suggest a direct involvement of microtubules and microfilaments in the development and evolution of inflammatory cardiomyopathies
Reply to Letter by Alexander Seibold on ââImpact of Switching from Intermittently Scanned to Real-Time Continuous Glucose Monitoring Systems in a Type 1 Diabetes Patient French Cohort: An Observational Study of Clinical Practicesââ by Yannis PrĂ©au, et al.
International audienc
Benefits of a Switch from Intermittently Scanned Continuous Glucose Monitoring (isCGM) to Real-Time (rt) CGM in Diabetes Type 1 Suboptimal Controlled Patients in Real-Life: A One-Year Prospective Study
International audienceThe switch from intermittently scanned continuous glucose monitoring (isCGM) to realtime (rt) CGM could improve glycemic management in suboptimal controlled type 1 diabetes patients, but long-term study is lacking. We evaluated retrospectively the ambulatory glucose profile (AGP) in such patients after switching from Free Style Libre 1 (FSL1) to Dexcom G4 (DG4) biosensors over 1 year. Patients (n = 21, 43 ± 15 years, BMI 25 ± 5, HbA1c 8.1 ± 1.0%) had severe hypoglycemia and/or HbA1c ℠8%. AGP metrics (time-in-range (TIR) 70-180 mg/dL, time-below-range (TBR) 180 mg/dL or >250 mg/dL, glucose management indicator (GMI), average glucose) were collected the last 3 months of FSL1 use (M0) and of DG4 for 3, 6 (M6) and 12 (M12) months of use. Values were means ± standard deviation or medians [Q1;Q3]. At M12 versus M0, the higher TIR (50 ± 17 vs. 45 ± 16, p = 0.036), and lower TBR < 70 mg/dL (2.5 [1.6;5.5] vs. 7.0 [4.5;12.5], p = 0.0007), TBR < 54 mg/dL (0.7 [0.4;0.8] vs. 2.3 [0.8;7.0], p = 0.007) and %CV (39 ± 5 vs. 45 ± 8, p = 0.0009), evidenced a long-term effectiveness of the switch. Compared to M6, TBR < 70 mg/dL decreased, %CV remained stable, while the improvement on hyperglycemia exposure decreased (higher GMI, TAR and average glucose). This switch was a relevant therapeutic option, though a loss of benefit on hyperglycemia stressed the need for optimized management of threshold alarms. Nevertheless, few patients attained the recommended values for AGP metrics, and the reasons why some patients are "responders" vs. "non-responders" warrant to be investigated
What are the psychosocial determinants of participation in colorectal cancer screening ? A french qualitative study
International audienc
Impact of Switching from Intermittently Scanned to Real-Time Continuous Glucose Monitoring Systems in a Type 1 Diabetes Patient French Cohort: An Observational Study of Clinical Practices
International audienceAim: Assess the impact of switching from intermittently scanned (FreeStyle Libre [FSL]) to real-time (Dexcom G4 platinum [DG4]) continuous glucose monitoring systems on glycemia control in type 1 diabetes (T1D) patients with high risk of hypoglycemia and/or elevated glycated hemoglobin (HbA1c). Methods: We conducted an observational study in 18 T1D adults with poor glycemic control on FSL. Ambulatory glucose profile data were collected during the last 3 months of FSL use before inclusion (M0 period), during the first 3 months (M3 period) and the last 3 months (M6 period) of DG4 use. Data were then expressed as 24-h averages. Biological HbA1c was measured for all three periods. Patients were their own-controls and statistics were performed using paired t-test or Wilcoxon for matched-pairs. Results: The switch to DG4 at M3 resulted in a higher time-in-range (TIR) 70-180 mg/dL (median [Q1;Q3], 53.1 [44.5;67.3] vs. 41.5 [28.5;62.0], P = 0.0008), and a lower time-below-range <70 mg/dL (TBR mean-standard deviation (SD), 5.4-3.7 vs. 10.9-7.1, P = 0.0009) and in the glucose % coefficient of variation (%CV mean-SD, 40.1 vs. 46.9, P = 0.0001). Mean (SD) changes were +10.3 (8.0) percentage points for TIR,-5.5 (5.8) percentage points for TBR, and-6.8 (5.8) percentage points for %CV. These results were confirmed at the M6 period. Conclusions: Switching from FSL to DG4 appears to provide a beneficial therapeutic option without changing insulin delivery systems, regardless of the origin of the patient's initial glycemic issue
Benefits of a Switch From Intermittently Scanned Continuous Glucose Monitoring (isCGM) to Real-time (rt) CGM in Diabetes Type 1 Suboptimal Controlled Patients in Real-life: A One-year Prospective Study
The switch from intermittently scanned continuous glucose monitoring (isCGM) to realtime (rt) CGM could improve glycemic management in suboptimal controlled type 1 diabetes patients, but long-term study is lacking. We evaluated retrospectively the ambulatory glucose profile (AGP) in such patients after switching from Free Style libre 1 (FSL1) to Dexcom G4 (DG4) over 1 year. Patients (n=21, 43±15 years, BMI 25±5, HbA1c 8.1±1.0%) had severe hypoglycemia and/or HbA1câ„8%. AGP metrics (time-in-range (TIR) 70-180 mg/dL, time-below-range (TBR) 180 mg/dL or >250 mg/dL, glucose management indicator (GMI), average glucose) were collected the last 3 months of FSL1 use (M0) and of DG4 for 3, 6 (M6) and 12 (M12) months of use. Values were means ± standard deviation or medians [Q1;Q3]. At M12 versus M0, the higher TIR (50±17 vs. 45±16, P=0.036), and lower TBR<70 mg/dL (2.5 [1.6;5.5] vs. 7.0 [4.5;12.5], P=0.0007), TBR<54 mg/dL (0.7 [0.4;0.8] vs. 2.3 [0.8;7.0], P=0.007) and %CV (39±5 vs. 45±8, P=0.0009), evidenced a long-term effectiveness of the switch. Compared to M6, TBR<70mg/dL decreased, %CV remained stable, while the improvement on hyperglycemia exposure decreased (higher GMI, TAR and average glucose). This switch was a relevant therapeutic option, though a loss of benefit on hyperglycemia stressed the need for optimized management of threshold alarms. Nevertheless, few patients attained the recommended values for AGP metrics, and the reasons why some patients are "responders" vs "non-responders" warrant to be investigated
Influence de lâinformation et de la modification des comportements sur le dĂ©veloppement post traumatique aprĂšs un cancer
International audienc