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Orléans, France

Schortgen F.,Assistance Publique Hopitaux de Paris AP HP | Schortgen F.,French Institute of Health and Medical Research | Clabault K.,University of Rouen | Katsahian S.,AP HP | And 12 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2012

Rationale: Fever control may improve vascular tone and decrease oxygen consumption, but fever may contribute to combat infection. Objectives: To determine whether fever control by external cooling diminishes vasopressor requirements in septic shock. Methods: In a multicenter randomized controlled trial, febrile patients with septic shock requiring vasopressors, mechanical ventilation, and sedation were allocated to external cooling (n = 101) to achieve normothermia (36.5-37°C) for 48 hours or no external cooling (n = 99). Vasopressors were tapered to maintain the same blood pressure target in the two groups. The primary endpoint was the numberof patients with a 50% decrease in baseline vasopressor dose after 48 hours. Measurements and Main Results: Body temperature was significantly lower in the cooling group after 2 hours of treatment (36.8 ± 0.7 vs. 38.4 ± 1.1°C; P < 0.01). A 50% vasopressor dose decrease was significantly more common with external cooling from 12 hours of treatment (54 vs. 20%; absolute difference, 34%; 95% confidence interval [95% CI], -46 to -21; P < 0.001) but not at 48 hours (72 vs. 61%; absolute difference,11%; 95% CI, -23 to 2). Shock reversal during the intensive care unit stay was significantly more common with cooling (86 vs. 73%; absolute difference,13%; 95% CI, 2 to 25; P=0.021). Day-14 mortality was significantly lower in the cooling group (19 vs. 34%; absolute difference, -16%; 95% CI, -28 to -4; P = 0.013). Conclusions: In this study, fever control using external cooling was safe and decreased vasopressor requirements and early mortality in septic shock. Copyright © 2012 by the American Thoracic Society. Source

Sztrymf B.,Reanimation Polyvalente | Sztrymf B.,French Institute of Health and Medical Research | Gunther S.,University Paris - Sud | Humbert M.,University Paris - Sud | Humbert M.,French Institute of Health and Medical Research
Reanimation | Year: 2014

Pulmonary arterial hypertension is a disease affecting the small pulmonary arteries leading to a progressive right heart failure and ultimately to death if untreated. Episodes of acute right heart failure may occur during the course of this chronic disease. These episodes are severe and seem to have an influence on the course of the underlying disease. To date, there are no consensual standardized guidelines and therapeutics relies on the management of the major pathophysiological endpoints in this setting. The issue of monitoring is also unsolved. After a review of pulmonary arterial hypertension management in stable condition, we will consider these points, in order to avoid potential pitfalls in the management of such patients harboring right ventricular failure. © 2013 Société de réanimation de langue française (SRLF) and Springer-Verlag France. Source

Guidet B.,Reanimation medicale | Guidet B.,University Pierre and Marie Curie | Guidet B.,French Institute of Health and Medical Research | Martinet O.,Reanimation medicale | And 10 more authors.
Critical Care | Year: 2012

Introduction: Inadequate initial treatment and delayed hemodynamic stabilization (HDS) may be associated with increased risk of death in severe sepsis patients.Methods: In order to compare the hemodynamic efficacy and safety of 6% HES 130/0.4 and NaCl 0.9% for HDS in patients with severe sepsis, we designed a prospective, multicenter, active-controlled, double-blind, randomized study in intensive care units.Results: 174 out of 196 patients reached HDS (88 and 86 patients for HES and NaCl, respectively). Significantly less HES was used to reach HDS vs. NaCl (1,379 ±886 ml in the HES group and 1,709 ±1,164 ml in the NaCl group (mean difference = -331± 1,033, 95% CI -640 to -21, P = 0.0185). Time to reach HDS was 11.8 10.1 hours vs. 14.3 ±11.1 hours for HES and NaCl, respectively. Total quantity of study drug infused over four consecutive days, ICU and hospital LOS, and area under the curve of SOFA score were comparable. Acute renal failure occurred in 24 (24.5%) and 19 (20%) patients for HES and NaCl, respectively (P = 0.454). There was no difference between AKIN and RIFLE criteria among groups and no difference in mortality, coagulation, or pruritus up to 90 days after treatment initiation.Conclusion: Significantly less volume was required to achieve HDS for HES vs. NaCl in the initial phase of fluid resuscitation in severe sepsis patients without any difference for adverse events in both groups.ClinicalTrials.gov: NCT00464204. © 2012 Guidet et al.; licensee BioMed Central Ltd. Source

Guerin C.,University of Lyon | Reignier J.,Roche Holding AG | Richard J.-C.,University of Lyon | Beuret P.,Reanimation Polyvalente | And 21 more authors.
New England Journal of Medicine | Year: 2013

BACKGROUND: Previous trials involving patients with the acute respiratory distress syndrome (ARDS) have failed to show a beneficial effect of prone positioning during mechanical ventilatory support on outcomes. We evaluated the effect of early application of prone positioning on outcomes in patients with severe ARDS. METHODS: In this multicenter, prospective, randomized, controlled trial, we randomly assigned 466 patients with severe ARDS to undergo prone-positioning sessions of at least 16 hours or to be left in the supine position. Severe ARDS was defined as a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (FIO2) of less than 150 mm Hg, with an FIO2 of at least 0.6, a positive end-expiratory pressure of at least 5 cm of water, and a tidal volume close to 6 ml per kilogram of predicted body weight. The primary outcome was the proportion of patients who died from any cause within 28 days after inclusion. RESULTS: A total of 237 patients were assigned to the prone group, and 229 patients were assigned to the supine group. The 28-day mortality was 16.0% in the prone group and 32.8% in the supine group (P<0.001). The hazard ratio for death with prone positioning was 0.39 (95% confidence interval [CI], 0.25 to 0.63). Unadjusted 90-day mortality was 23.6% in the prone group versus 41.0% in the supine group (P<0.001), with a hazard ratio of 0.44 (95% CI, 0.29 to 0.67). The incidence of complications did not differ significantly between the groups, except for the incidence of cardiac arrests, which was higher in the supine group. CONCLUSIONS: In patients with severe ARDS, early application of prolonged prone-positioning sessions significantly decreased 28-day and 90-day mortality. (Funded by the Programme Hospitalier de Recherche Clinique National 2006 and 2010 of the French Ministry of Health; PROSEVA ClinicalTrials.gov number, NCT00527813.) Copyright © 2013 Massachusetts Medical Society. Source

Grandeau E.,Unite de Pharmacie Clinique Oncologique | Turbelin A.,Reanimation Polyvalente | Schmidt J.,Medecine Interne | Gras-Champel V.,Center Regional Of Pharmacovigilance | Chourbagi C.,Unite de Pharmacie Clinique Oncologique
Therapie | Year: 2014

We present a serious case of bradykinin mediated angioedema with upper airway disorders resulting from drug interaction between angiotensin-converting enzyme inhibitors and immunosuppressant agents. © 2014 Socié té Française de Pharmacologie et de Thérapeutique. Source

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