Meybohm P.,University Hospital Frankfurt |
Aken H.V.,Universitatsklinikum Munster |
Hert S.D.,Ghent University |
Rocca G.D.,University of Udine |
And 14 more authors.
Critical Care | Year: 2013
Introduction: Hydroxyethyl starch (HES) is a commonly used colloid in critically ill patients. However, its safety has been questioned in recent studies and meta-analyses. Methods: We re-evaluated prospective randomised controlled trials (RCT) from four meta-analyses published in 2013 that compared the effect of HES with crystalloids in critically ill patients, focusing on the adherence to 'presumably correct indication'. Regarding the definition of 'presumably correct indication', studies were checked for the following six criteria (maximum six points): short time interval from shock to randomisation (<6 h), restricted use for initial volume resuscitation, use of any consistent algorithm for haemodynamic stabilisation, reproducible indicators of hypovolaemia, maximum dose of HES, and exclusion of patients with pre-existing renal failure or renal replacement therapy. Results: Duration of fluid administration ranged from 90 min up to a maximum of 90 days. Four studies considered follow-up until 90-day mortality, three studies 28-/30-day mortality, whereas four studies reported only early mortality. Included studies showed a large heterogeneity of the indication score ranging between 1 and 4 points with a median (25%; 75% quartile) of 4 (2; 4). Conclusions: The most important question, whether or not HES may be harmful when it is limited to immediate haemodynamic stabilisation, cannot be answered yet in the absence of any study sufficiently addressing this question. In order to overcome the limitations of most of the previous studies, we now suggest an algorithm emphasising the strict indication of HES. Additionally, we give a list of suggestions that should be adequately considered in any prospective RCT in the field of acute volume resuscitation in critically ill patients. © 2013 Meybohm et al.; licensee BioMed Central Ltd.
PubMed | Claude Huriez University Hospital, Pellegrin University Hospital, University of Nantes, Saint Antoine University Hospital and 26 more.
Type: Journal Article | Journal: Journal of visceral surgery | Year: 2014
Despite the prevalence of complex ventral hernias, there is little agreement on the most appropriate technique or prosthetic to repair these defects, especially in contaminated fields. Our objective was to determine French surgical practice patterns among academic surgeons in complex ventral hernia repair (CVHR) with regard to indications, most appropriate techniques, choice of prosthesis, and experience with complications.A survey consisting of 21 questions and 6 case-scenarios was e-mailed to French practicing academic surgeons performing CVHR, representing all French University Hospitals.Forty over 54 surgeons (74%) responded to the survey, representing 29 French University Hospitals. Regarding the techniques used for CVHR, primary closure without reinforcement was provided in 31.6% of cases, primary closure using the component separation technique without mesh use in 43.7% of cases, mesh positioned as a bridge in 16.5% of cases, size reduction of the defect by using aponeurotomy incisions without mesh use in 8.2% of cases. Among the 40 respondents, 36 had experience with biologic mesh. There was a strong consensus among surveyed surgeons for not using synthetic mesh in contaminated or dirty fields (100%), but for using it in clean settings (100%). There was also a strong consensus between respondents for using biologic mesh in contaminated (82.5%) or infected (77.5%) fields and for not using it in clean setting (95%). In clean-contaminated surgery, there was no consensus for defining the optimal therapeutic strategy in CVHR. Infection was the most common complication reported after biologic mesh used (58%). The most commonly reported influences for the use of biologic grafts included literature, conferences and discussion with colleagues (85.0%), personal experience (45.0%) and cost (40.0%).Despite a lack of level I evidence, biologic meshes are being used by 90% of surveyed surgeons for CVHR. Importantly, there was a strong consensus for using them in contaminated or infected fields and for not using them in clean setting. To better guide surgeons, prospective, randomized trials should be undertaken to evaluate the short- and long-term outcomes associated with these materials in various surgical wound classifications.
Briez N.,University Hospital |
Briez N.,Lille 2 University of Health and Law |
Piessen G.,University Hospital |
Piessen G.,Lille 2 University of Health and Law |
And 16 more authors.
BMC Cancer | Year: 2011
Background: Open transthoracic oesophagectomy is the standard treatment for infracarinal resectable oesophageal carcinomas, although it is associated with high mortality and morbidity rates of 2 to 10% and 30 to 50%, respectively, for both the abdominal and thoracic approaches. The worldwide popularity of laparoscopic techniques is based on promising results, including lower postoperative morbidity rates, which are related to the reduced postoperative trauma. We hypothesise that the laparoscopic abdominal approach (laparoscopic gastric mobilisation) in oesophageal cancer surgery will decrease the major postoperative complication rate due to the reduced surgical trauma.Methods/Design: The MIRO trial is an open, controlled, prospective, randomised multicentre phase III trial. Patients in study arm A will receive laparoscopic-assisted oesophagectomy, i.e., a transthoracic oesophagectomy with two-field lymphadenectomy and laparoscopic gastric mobilisation. Patients in study arm B will receive the same procedure, but with the conventional open abdominal approach. The primary objective of the study is to evaluate the major postoperative 30-day morbidity. Secondary objectives are to assess the overall 30-day morbidity, 30-day mortality, 30-day pulmonary morbidity, disease-free survival, overall survival as well as quality of life and to perform medico-economic analysis. A total of 200 patients will be enrolled, and two safety analyses will be performed using 25 and 50 patients included in arm A.Discussion: Postoperative morbidity remains high after oesophageal cancer surgery, especially due to major pulmonary complications, which are responsible for 50% of the postoperative deaths. This study represents the first randomised controlled phase III trial to evaluate the benefits of the minimally invasive approach with respect to the postoperative course and oncological outcomes in oesophageal cancer surgery.Trial Registration: NCT00937456 (ClinicalTrials.gov). © 2011 Briez et al; licensee BioMed Central Ltd.
Blot S.,Ghent University |
Koulenti D.,National and Kapodistrian University of Athens |
Koulenti D.,University of Queensland |
Dimopoulos G.,National and Kapodistrian University of Athens |
And 6 more authors.
Critical Care Medicine | Year: 2014
OBJECTIVE:: We investigated the epidemiology of ventilator-Associated pneumonia in elderly ICU patients. More precisely, we assessed prevalence, risk factors, signs and symptoms, causative bacterial pathogens, and associated outcomes. DESIGN:: Secondary analysis of a multicenter prospective cohort (EU-VAP project). SETTING:: Twenty-seven European ICUs. PATIENTS:: Patients who were mechanically ventilated for greater than or equal to 48 hours. We compared middle-Aged (45-64 yr; n = 670), old (65-74 yr; n = 549), and very old patients (≥ 75 yr; n= 516). MEASUREMENTS AND MAIN RESULTS:: Ventilator-Associated pneumonia occurred in 103 middle-Aged (14.6%), 104 old (17.0%), and 73 very old patients (12.8%). The prevalence (n ventilator-Associated pneumonia/1,000 ventilation days) was 13.7 in middle-Aged patients, 16.6 in old patients, and 13.0 in very old patients. Logistic regression analysis could not demonstrate older age as a risk factor for ventilator-Associated pneumonia. Ventilator-Associated pneumonia in elderly patients was more frequently caused by Enterobacteriaceae (24% in middle-Aged, 32% in old, and 43% in very old patients; p = 0.042). Regarding clinical signs and symptoms at ventilator-Associated pneumonia onset, new temperature rise was less frequent among very old patients (59% vs 76% and 74% for middle-Aged and old patients, respectively; p = 0.035). Mortality among patients with ventilator-Associated pneumonia was higher among elderly patients: 35% in middle-Aged patients versus 51% in old and very old patients (p = 0.036). Logistic regression analysis confirmed the importance of older age in the risk of death (adjusted odds ratio for old age, 2.1; 95% CI, 1.2-3.9 and adjusted odds ratio for very old age, 2.3; 95% CI, 1.2-4.4). Other risk factors for mortality in ventilator-Associated pneumonia were diabetes mellitus, septic shock, and a high-risk pathogen as causative agent. CONCLUSIONS:: In this multicenter cohort study, ventilator-Associated pneumonia did not occur more frequently among elderly, but the associated mortality in these patients was higher. New temperature rise was less common in elderly patients with ventilator-Associated pneumonia, whereas more episodes among elderly patients were caused by Enterobacteriaceae. Copyright © 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
Boyer L.,La Timone University Hospital |
Dassa D.,Conception University Hospital |
Belzeaux R.,Sainte Marguerite University Hospital |
Henry J.-M.,Conception University Hospital |
And 3 more authors.
Psychiatric Services | Year: 2011
Objective: This study examined characteristics of frequent visitors to a psychiatric emergency service in a French public teaching hospital over six years. Diagnostic variability of psychotic disorders was documented. Methods: A retrospective review of the service's administrative and medical databases identified 1,285 patients with more than one visit during the period who were given at least one diagnosis of a psychotic disorder. A total of 317 patients with six or more visits (frequent visitors) were compared with 968 patients with between two and five visits (occasional visitors). Results: Frequent visitors were significantly more likely to be single and homeless and to have diagnostic variability, substance use disorders, and personality disorders. A total of 177 patients experienced diagnostic variability, which was found mainly in three diagnostic categories: schizophrenia, schizoaffective disorder, and bipolar disorder with psychotic features. Conclusions: Future studies should further examine the link between increased use of emergency services and diagnostic variability.
Baumstarck-Barrau K.,Nord University Hospital |
Simeoni M.-C.,Nord University Hospital |
Reuter F.,Timone University Hospital |
Klemina I.,Timone University Hospital |
And 3 more authors.
BMC Neurology | Year: 2011
Background: Nearly half of all patients diagnosed with multiple sclerosis (MS) will develop cognitive dysfunction. Studies highlighted from no/weak impact to a strong impact of cognitive impairment on quality of life (QoL). The aim of this study was to assess the impact of cognitive dysfunction on self-reported QoL in MS patients while considering key confounding factors.Methods: Design: cross-sectional study. Inclusion criteria: MS patients of any disease subtype. Data collection: sociodemographic (age, gender, marital status, education level, and occupational activity) and clinical data (MS subtype, disease duration); MS disability (Expanded Disability Status Scale, EDSS); depression (Beck Depression Inventory); fatigue (Modified Fatigue Impact Scale); QoL (SF36 and MusiQoL); and neuropsychological performance (Brief Repeatable Battery of Neuropsychological Tests, BRB-N). Statistical analysis: multiple linear regressions (forward-stepwise selection).Results: One hundred and twenty-four patients were enrolled. Performance on BRB-N subtests varied widely (6% to 70% abnormal). The BRB-N classified 37-78% of the patients as cognitively impaired, depending on the definition of cognitive impairment. No links were found between the MusiQoL index and cognitive subtests, whereas marital status, EDSS, and depression were found to be independent predictive factors.Conclusions: The present study demonstrated the weak and scarce association between cognitive impairment and QoL, when the key confounding factors were considered. These results need to be confirmed with larger samples and more accurate tests of cognitive function. © 2011 Baumstarck-Barrau et al; licensee BioMed Central Ltd.
Baumstarck K.,Nord University Hospital |
Pelletier J.,Timone University Hospital |
Aghababian V.,Aix - Marseille University |
Reuter F.,Timone University Hospital |
And 4 more authors.
PLoS ONE | Year: 2012
Background: Cognitive impairment occurs in about 50% of multiple sclerosis (MS) patients, and the use of self-reported outcomes for evaluating treatment and managing care among subjects with cognitive dysfunction has been questioned. The aim of this study was to provide new evidence about the suitability of self-reported outcomes for use in this specific population by exploring the internal structure, reliability and external validity of a specific quality of life (QoL) instrument, the Multiple Sclerosis International Quality of Life questionnaire (MusiQoL). Methods: Design: cross-sectional study. Inclusion criteria: MS patients of any disease subtype. Data collection: sociodemographic (age, gender, marital status, education level, and occupational activity) and clinical data (MS subtype, Expanded Disability Status Scale, disease duration); QoL (MusiQoL and SF36); and neuropsychological performance (Stroop color-word test). Statistical analysis: confirmatory factor analysis, item-dimension correlations, Cronbach's alpha coefficients, Rasch statistics, relationships between MusiQoL dimensions and other parameters. Principal Findings: One hundred and twenty-four consecutive patients were enrolled. QoL scores did not differ between the 69 cognitively non-impaired patients and the 55 cognitively impaired patients, except for the symptoms dimension. The confirmatory factor analysis performed among the impaired subjects showed that the structure of the questionnaire matched with the initial structure of the MusiQoL. The unidimensionality of the MusiQoL dimensions was preserved, and the internal validity indices were satisfactory and close to those of the reference population. Conclusions/Significance: Our study suggests that executive dysfunction did not compromise the reliability and the validity of the self-reported QoL questionnaires. © 2012 Baumstarck et al.
Andres V.,La Conception University Hospital |
Garcia P.,La Conception University Hospital |
Rimet Y.,Regional Hospital |
Nicaise C.,Nord University Hospital |
Simeoni U.,La Conception University Hospital
Pediatrics | Year: 2011
The death or near death of a presumably healthy newborn in the delivery room is uncommon. We report here 6 cases of apparent life-threatening events (ALTEs) in the delivery room during the first 2 hours of life. In each case, the incident occurred in a healthy infant who was in a prone position on his or her mother's abdomen during early skinto-skin contact. In most cases, the mother was primiparous, and in all cases the mother and infant were not observed during the initiation of skin-to-skin contact and breastfeeding. There are many benefits of early skin-to-skin contact and breastfeeding in the delivery room. However, in view of the risk of a rare but significant ALTE, we suggest that surveillance of newborns is needed. Although many ALTEs are apparently caused by obstruction, we suggest that a standardized investigational workup be performed after an ALTE. Copyright © 2011 by the American Academy of Pediatrics.