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Article ; Online: Right atrial collapse mimicking cardiac tamponade in a patient on veno-arterial extracorporeal membrane oxygenation.

Saura, Ouriel / Combes, Alain / Hekimian, Guillaume

2024

Language	English
Publishing date	2024-05-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	80387-x
ISSN	1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
ISSN (online)	1432-1238
ISSN	0340-0964 ; 0342-4642 ; 0935-1701
DOI	10.1007/s00134-024-07439-y
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Article ; Online: Viral Ventilator-Associated Pneumonia/Hospital-Acquired Pneumonia.

Luyt, Charles-Edouard / Hékimian, Guillaume / Bréchot, Nicolas / Chastre, Jean

Seminars in respiratory and critical care medicine

2022 Volume 43, Issue 2, Page(s) 310–318

Abstract: Among the viruses possibly responsible for hospital-acquired and ventilator-associated pneumonia, herpes simplex virus (HSV) is probably the most often involved: HSV reactivation is frequent in intensive care unit patients, and lung parenchymal infection ...

Abstract	Among the viruses possibly responsible for hospital-acquired and ventilator-associated pneumonia, herpes simplex virus (HSV) is probably the most often involved: HSV reactivation is frequent in intensive care unit patients, and lung parenchymal infection (HSV bronchopneumonitis) has been well described, either using cytological signs of parenchymal involvement in cells obtained during bronchoalveolar lavage or using HSV virus load in the lower respiratory tract. Although treating patients with HSV bronchopneumonitis may be recommended, based on expert opinion, prophylactic or preemptive treatment of HSV reactivation should be avoided. Ventilator-associated pneumonia due to cytomegalovirus (CMV) is less frequent than HSV bronchopneumonitis, and more difficult to diagnose. No data exists on the impact of antiviral treatment on CMV pneumonia. The involvement of respiratory viruses has been described in patients with healthcare-associated pneumonia and hospital-acquired pneumonia, but their role in ventilator-associated pneumonia is not clear.
MeSH term(s)	Cytomegalovirus Infections ; Herpes Simplex/diagnosis ; Herpesviridae Infections ; Hospitals ; Humans ; Pneumonia, Ventilator-Associated/drug therapy ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/therapy ; Simplexvirus
Language	English
Publishing date	2022-01-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	1183617-9
ISSN	1098-9048 ; 1069-3424
ISSN (online)	1098-9048
ISSN	1069-3424
DOI	10.1055/s-0041-1740981
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Article: Antibiotic stewardship in the ICU: time to shift into overdrive.

Mokrani, David / Chommeloux, Juliette / Pineton de Chambrun, Marc / Hékimian, Guillaume / Luyt, Charles-Edouard

Annals of intensive care

2023 Volume 13, Issue 1, Page(s) 39

Abstract: Antibiotic resistance is a major health problem and will be probably one of the leading causes of deaths in the coming years. One of the most effective ways to fight against resistance is to decrease antibiotic consumption. Intensive care units (ICUs) ... ...

Abstract	Antibiotic resistance is a major health problem and will be probably one of the leading causes of deaths in the coming years. One of the most effective ways to fight against resistance is to decrease antibiotic consumption. Intensive care units (ICUs) are places where antibiotics are widely prescribed, and where multidrug-resistant pathogens are frequently encountered. However, ICU physicians may have opportunities to decrease antibiotics consumption and to apply antimicrobial stewardship programs. The main measures that may be implemented include refraining from immediate prescription of antibiotics when infection is suspected (except in patients with shock, where immediate administration of antibiotics is essential); limiting empiric broad-spectrum antibiotics (including anti-MRSA antibiotics) in patients without risk factors for multidrug-resistant pathogens; switching to monotherapy instead of combination therapy and narrowing spectrum when culture and susceptibility tests results are available; limiting the use of carbapenems to extended-spectrum beta-lactamase-producing Enterobacteriaceae, and new beta-lactams to difficult-to-treat pathogen (when these news beta-lactams are the only available option); and shortening the duration of antimicrobial treatment, the use of procalcitonin being one tool to attain this goal. Antimicrobial stewardship programs should combine these measures rather than applying a single one. ICUs and ICU physicians should be at the frontline for developing antimicrobial stewardship programs.
Language	English
Publishing date	2023-05-06
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	2617094-2
ISSN	2110-5820
ISSN	2110-5820
DOI	10.1186/s13613-023-01134-9
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Article ; Online: Venoarterial extracorporeal membrane oxygenation in immunocompromised patients with cardiogenic shock: a cohort study and propensity-weighted analysis.

Moyon, Quentin / Triboulet, Félicien / Reuter, Jean / Lebreton, Guillaume / Dorget, Amandine / Para, Marylou / Chommeloux, Juliette / Stern, Jules / Pineton de Chambrun, Marc / Hékimian, Guillaume / Luyt, Charles-Edouard / Combes, Alain / Sonneville, Romain / Schmidt, Matthieu

Intensive care medicine

2024 Volume 50, Issue 3, Page(s) 406–417

Abstract: Purpose: The outcomes of immunocompromised patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) are seldom documented, making ECMO candidacy decisions challenging. This study aims (1) to report outcomes ...

Abstract	Purpose: The outcomes of immunocompromised patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) are seldom documented, making ECMO candidacy decisions challenging. This study aims (1) to report outcomes of immunocompromised patients treated with VA-ECMO, (2) to identify pre-ECMO predictors of 90-day mortality, (3) to assess the impact of immunodepression on 90-day mortality, and (4) to describe the main ECMO-related complications. Methods: This is a retrospective, propensity-weighted study conducted in two French experienced ECMO centers. Results: From January 2006 to January 2022, 177 critically ill immunocompromised patients (median (interquartile range, IQR) age 49 (32-60) years) received VA-ECMO. The main causes of immunosuppression were long-term corticosteroids/immunosuppressant treatment (29%), hematological malignancy (26%), solid organ transplant (20%), and solid tumor (13%). Overall 90-day and 1-year mortality were 70% (95% confidence interval (CI) 63-77%) and 75% (95% CI 65-79%), respectively. Older age and higher pre-ECMO lactate were independently associated with 90-day mortality. Across immunodepression causes, 1-year mortality ranged from 58% for patients with infection by human immunodeficiency virus (HIV) or asplenia, to 89% for solid organ transplant recipients. Hemorrhagic and infectious complications affected 39% and 54% of patients, while more than half the stay in intensive care unit (ICU) was spent on antibiotics. In a propensity score-weighted model comparing the 177 patients with 942 non-immunocompromised patients experiencing cardiogenic shock on VA-ECMO, immunocompromised status was independently associated with a higher 90-day mortality (odds ratio 2.53, 95% CI 1.72-3.79). Conclusion: Immunocompromised patients undergoing VA-ECMO treatment face an unfavorable prognosis, with higher 90-day mortality compared to non-immunocompromised patients. This underscores the necessity for thorough evaluation and careful selection of ECMO candidates within this frail population.
MeSH term(s)	Humans ; Middle Aged ; Shock, Cardiogenic/etiology ; Retrospective Studies ; Extracorporeal Membrane Oxygenation/adverse effects ; Cohort Studies ; Immunocompromised Host
Language	English
Publishing date	2024-03-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	80387-x
ISSN	1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
ISSN (online)	1432-1238
ISSN	0340-0964 ; 0342-4642 ; 0935-1701
DOI	10.1007/s00134-024-07354-2
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Zs.A 1089: Show issues

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Article: Authors reply in response to a letter on: "Diagnostic yield, safety and therapeutic consequences of myocardial biopsy in clinically suspected fulminant myocarditis unweanable from mechanical circulatory support".

Pineton de Chambrun, Marc / Marquet, Yann / Kerneis, Mathieu / Schmidt, Matthieu / Luyt, Charles-Edouard / Combes, Alain / Hekimian, Guillaume

Annals of intensive care

2024 Volume 14, Issue 1, Page(s) 3

Language	English
Publishing date	2024-01-06
Publishing country	Germany
Document type	Letter
ZDB-ID	2617094-2
ISSN	2110-5820
ISSN	2110-5820
DOI	10.1186/s13613-023-01237-3
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Article ; Online: Bleeding complications, coagulation disorders, and their management in acute myocardial infarction-related cardiogenic shock rescued by veno-arterial ECMO: A retrospective cohort study.

Masi, Paul / Gendreau, Ségolène / Moyon, Quentin / Leguyader, Maxence / Lebreton, Guillaume / Ropers, Jacques / Dangers, Laurence / Sitruk, Samuel / Bréchot, Nicolas / Pineton de Chambrun, Marc / Chommeloux, Juliette / Schmidt, Matthieu / Luyt, Charles Edouard / Leprince, Pascal / Combes, Alain / Frere, Corinne / Hékimian, Guillaume

Journal of critical care

2024 Volume 82, Page(s) 154771

Abstract: Purpose: Management of dual antiplatelet therapy (DAPT) in patients on venoarterial-extracorporeal membrane (VA-ECMO) after acute myocardial infarction (AMI) is challenging. Our objective was to describe the frequency, management and outcomes of severe ... ...

Abstract	Purpose: Management of dual antiplatelet therapy (DAPT) in patients on venoarterial-extracorporeal membrane (VA-ECMO) after acute myocardial infarction (AMI) is challenging. Our objective was to describe the frequency, management and outcomes of severe bleeding complications and determine their occurrence risk factors. Material and methods: We conducted a retrospective observational cohort study including post-AMI cardiogenic shock patients requiring VA-ECMO. Severe bleeding was defined based on the Bleeding Academic Research Consortium classification. We calculated multivariable Fine-Gray models to assess factors associated with risk of severe bleeding. Results: From January 2015 to July 2019, 176 patients received VA-ECMO after AMI and 132 patients were included. Sixty-five (49%) patients died. Severe bleeding occurred in 39% of cases. Severe thrombocytopenia (< 50 G/L) and hypofibrinogenemia (<1,5 g/L) occurred in respectively 31% and 19% of patients. DAPT was stopped in 32% of patients with a 6% rate of stent thrombosis. Anticoagulation was stopped in 39% of patients. Using a multivariate competing risk model, female sex, time on ECMO, troponin at admission and Impella® implantation were independently associated with severe bleeding. Conclusions: Bleeding complications and coagulation disorders were frequent and severe in patients on VA-ECMO after AMI, leading of antiplatelet therapy withdrawal in one third of patients.
Language	English
Publishing date	2024-03-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2024.154771
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Zs.A 2152: Show issues

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Article: Recurrent ventilator-associated pneumonia in severe Covid-19 ARDS patients requiring ECMO support.

Collado-Lledó, Elena / Moyon, Quentin / Chommeloux, Juliette / Pineton de Chambrun, Marc / Hékimian, Guillaume / Saura, Ouriel / Lévy, David / Schmidt, Matthieu / Combes, Alain / Luyt, Charles-Edouard / Le Fevre, Lucie

Annals of intensive care

2024 Volume 14, Issue 1, Page(s) 67

Abstract: Objective: To describe ventilator-associated pneumonia (VAP) recurrence in COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO) support, and to evaluate the impact of antimicrobial treatment duration of the first VAP episode on VAP ... ...

Abstract	Objective: To describe ventilator-associated pneumonia (VAP) recurrence in COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO) support, and to evaluate the impact of antimicrobial treatment duration of the first VAP episode on VAP recurrence. Methods: Adult patients with COVID-19 severe pneumonia on ECMO admitted between March 2020 and January 2022 were retrospectively included. Primary outcome was incidence of VAP recurrence, and secondary outcome was the impact of duration of antimicrobial treatment on VAP recurrence. Results: Among the 252 included patients, 226 (90%) developed a first VAP. Sixteen had lung abscess and were excluded, leaving 210 patients. VAP recurrence occurred in 172 patients (82%), with a median (IQR) time from first VAP to recurrence of 10 (7-13) days. Pseudomonas aeruginosa and Enterobacteriaceae were respectively responsible for 28% and 52% of first VAP, and 51% and 62% of first recurrence episodes. Among the 210 patients with a first VAP, 158 (75%) received a short course of antibiotics [< 8 days, median (IQR) duration 6 (5-7) days] and 52 (25%) received a prolonged course of antibiotics [≥ 8 days, median (IQR) duration 9 (8-10) days]. Estimated cumulative incidence of VAP recurrence, taking into account death and extubation as competing risks, was not different in patients with short- and prolonged-antimicrobial treatment. Conclusions: In patients with severe Covid-19-ARDS requiring ECMO support, VAP recurrence occurs frequently, with Enterobacteriaceae and Pseudomonas aeruginosa as predominant causative microorganisms. An antimicrobial treatment of ≥ 8 days for the treatment of first VAP episode did not reduce the risk of VAP recurrence, as compared to shorter duration.
Language	English
Publishing date	2024-04-25
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2617094-2
ISSN	2110-5820
ISSN	2110-5820
DOI	10.1186/s13613-024-01295-1
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Article ; Online: Corrigendum to "Venoarterial extracorporeal membrane oxygenation flow or dobutamine to improve microcirculation during ECMO for refractory cardiogenic shock" [Journal of Critical Care 71 (2022) Start page 1 - End page 1 /154090].

Chommeloux, Juliette / Montero, Santiago / Franchineau, Guillaume / Lebreton, Guillaume / Bréchot, Nicolas / Barhoum, Petra / Lefèvre, Lucie / de Chambrun, Marc Pineton / Hékimian, Guillaume / Luyt, Charles-Edouard / Combes, Alain / Schmidt, Matthieu

Journal of critical care

2022 Volume 72, Page(s) 154193

Language	English
Publishing date	2022-11-08
Publishing country	United States
Document type	Published Erratum
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2022.154193
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Article ; Online: Severe pulmonary embolism in COVID-19 patients: a call for increased awareness.

Hékimian, Guillaume / Lebreton, Guillaume / Bréchot, Nicolas / Luyt, Charles-Edouard / Schmidt, Matthieu / Combes, Alain

Critical care (London, England)

2020 Volume 24, Issue 1, Page(s) 274

MeSH term(s)	Adult ; Aged ; COVID-19 ; Coronavirus Infections/epidemiology ; Coronavirus Infections/therapy ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Pandemics ; Paris/epidemiology ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/therapy ; Pulmonary Embolism/epidemiology ; Retrospective Studies ; Severity of Illness Index
Keywords	covid19
Language	English
Publishing date	2020-06-02
Publishing country	England
Document type	Letter
ZDB-ID	2041406-7
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/s13054-020-02931-5
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Zs.A 5517: Show issues

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Article ; Online: Increasing sweep gas flow reduces respiratory drive and dyspnea in non-intubated veno-arterial ECMO patients - a pilot study.

Bureau, Côme / Schmidt, Matthieu / Chommeloux, Juliette / Rivals, Isabelle / Similowski, Thomas / Hékimian, Guillaume / Luyt, Charles-Edouard / Niérat, Marie-Cécile / Dangers, Laurence / Dres, Martin / Combes, Alain / Morélot-Panzini, Capucine / Demoule, Alexandre

Anesthesiology

2024

Abstract: Background.: Data on assessment and management of dyspnea in patients on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock are lacking. We hypothesized that increasing sweep gas flow through the VA-ECMO oxygenator may ... ...

Abstract	Background.: Data on assessment and management of dyspnea in patients on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock are lacking. We hypothesized that increasing sweep gas flow through the VA-ECMO oxygenator may decrease dyspnea in non-intubated VA-ECMO patients exhibiting clinically significant dyspnea, with a parallel reduction in respiratory drive. Methods.: Non-intubated, spontaneously breathing, supine patients on VA-ECMO for cardiogenic shock who presented with a visual analog dyspnea scale (dyspnea-VAS) ≥ 40/100 mm were included. Sweep gas flow was increased up to +6 L/min by three steps of +2 L/min each. Dyspnea was assessed with dyspnea-VAS and Multidimensional Dyspnea Profile. The respiratory drive was assessed by the electromyographic activity of the alae nasi and parasternal muscles. Results.: We included 21 patients. On inclusion, median dyspnea-VAS was 50 ([interquartile range] 45-60) mm and sweep gas flow was 1.0 L/min (0.5-2.0). An increase in sweep gas flow significantly decreased dyspnea-VAS (50[45-60] at baseline vs 20[10-30] at 6L/min; p<0.001). The decrease in dyspnea was greater for the sensory component of dyspnea (-50%[43-75]) than for the affective and emotional components (-17%[0-25] and -12%[0-17], p<0.001). An increase in sweep gas flow significantly decreased electromyographic activity of the alae nasi and parasternal muscles (-23%[36-10] and -20[41-0], p<0.001). There was a significant correlation between the sweep gas flow and the dyspnea-VAS (r=-0.91 95%CI[-0.94, -0.87]), between the respiratory drive and the sensory component of dyspnea (r=0.29 95%CI[0.13, 0.44]), between the respiratory drive and the affective component of dyspnea (r=0.29 95%CI[0.02, 0.54]) and between the sweep gas flow and the alae nasi and parasternal (r=-0.31 95%CI[-0.44, -0.22] and r=-0.25 95%CI[-0.44, -0.16]). Conclusion.: In critically ill patients with VA-ECMO, an increase in sweep gas flow through the oxygenation membrane decreases dyspnea, possibly mediated by a decrease in respiratory drive.
Language	English
Publishing date	2024-03-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	269-0
ISSN	1528-1175 ; 0003-3022
ISSN (online)	1528-1175
ISSN	0003-3022
DOI	10.1097/ALN.0000000000004962
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