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  1. Article ; Online: Antiphospholipid Patients Admitted in the Intensive Care Unit: What Must The Rheumatologist Know?

    Moyon, Quentin / Mathian, Alexis / Papo, Matthias / Combes, Alain / Amoura, Zahir / Pineton de Chambrun, Marc

    Current rheumatology reports

    2024  

    Abstract: Purpose of the review: Antiphospholipid syndrome (APS) is a rare systemic autoimmune disorder that can escalate into a 'thrombotic storm' called the catastrophic antiphospholipid syndrome (CAPS), frequently requiring ICU admission for multiple organ ... ...

    Abstract Purpose of the review: Antiphospholipid syndrome (APS) is a rare systemic autoimmune disorder that can escalate into a 'thrombotic storm' called the catastrophic antiphospholipid syndrome (CAPS), frequently requiring ICU admission for multiple organ failure. This review aims to offer insight and recent evidence on critically-ill APS patients.
    Recent findings: The CAPS classification criteria define this condition as the involvement of at least three organs/systems/tissues within less than a week, caused by small vessel thrombosis, in patients with elevated antiphospholipid antibodies levels. These criteria do not encompass the full spectrum of critically-ill thrombotic APS patients and they need to be cautiously used for the bedside diagnosis of CAPS. Thrombocytopenia is the laboratory hallmark of CAPS, sometimes dropping below 20G/L, but a complete thrombotic microangiopathy pattern is infrequent. Anticoagulation is the pivotal treatment for APS and CAPS, associated with improved outcome. Triple therapy - the combination of anticoagulation, high-dose corticosteroids, and either plasma exchange or intravenous immunoglobulins - remains the standard treatment for CAPS patients. Eculizumab, an anti-C5 monoclonal antibody, may be useful in refractory patients. Despite significant progress, CAPS mortality rate remains high. Its diagnosis and management are complex, requiring a close multidisciplinary cross talk between APS specialists and intensivists.
    Language English
    Publishing date 2024-04-23
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2057357-1
    ISSN 1534-6307 ; 1523-3774
    ISSN (online) 1534-6307
    ISSN 1523-3774
    DOI 10.1007/s11926-024-01148-7
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    Zs.A 5531: Show issues Location:
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  2. Article ; Online: Who? When? Where? How? Still the alpha and omega of extracorporeal cardiopulmonary resuscitation.

    Pineton de Chambrun, Marc / Combes, Alain

    European heart journal. Acute cardiovascular care

    2022  Volume 11, Issue 4, Page(s) 290–292

    MeSH term(s) Cardiopulmonary Resuscitation ; Heart Arrest/therapy ; Humans ; Treatment Outcome
    Language English
    Publishing date 2022-05-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 2663340-1
    ISSN 2048-8734 ; 2048-8726
    ISSN (online) 2048-8734
    ISSN 2048-8726
    DOI 10.1093/ehjacc/zuac039
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  3. Article ; Online: High frequency of antiphospholipid antibodies in critically ill COVID-19 patients: a link with hypercoagulability?

    Pineton de Chambrun, M / Frere, C / Miyara, M / Amoura, Z / Martin-Toutain, I / Mathian, A / Hekimian, G / Combes, A

    Journal of internal medicine

    2020  Volume 289, Issue 3, Page(s) 422–424

    MeSH term(s) Adult ; Antibodies, Antiphospholipid/immunology ; COVID-19/immunology ; Critical Illness ; France ; Humans ; Male ; Middle Aged ; Pandemics ; Pneumonia, Viral/immunology ; Pneumonia, Viral/virology ; Prognosis ; Retrospective Studies ; SARS-CoV-2 ; Thrombophilia/immunology
    Chemical Substances Antibodies, Antiphospholipid
    Keywords covid19
    Language English
    Publishing date 2020-07-13
    Publishing country England
    Document type Letter
    ZDB-ID 96274-0
    ISSN 1365-2796 ; 0954-6820
    ISSN (online) 1365-2796
    ISSN 0954-6820
    DOI 10.1111/joim.13126
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  4. Article ; Online: Response to Letter: 'Reply to "High frequency of antiphospholipid antibodies in critically ill COVID-19 patients: a link with hypercoagulability?"'.

    Pineton de Chambrun, M / Frere, C / Miyara, M / Amoura, Z / Martin-Toutain, I / Mathian, A / Hekimian, G / Combes, A

    Journal of internal medicine

    2020  Volume 289, Issue 3, Page(s) 427–429

    MeSH term(s) Antibodies, Antiphospholipid ; COVID-19 ; Critical Illness ; Humans ; SARS-CoV-2 ; Thrombophilia
    Chemical Substances Antibodies, Antiphospholipid
    Keywords covid19
    Language English
    Publishing date 2020-09-14
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 96274-0
    ISSN 1365-2796 ; 0954-6820
    ISSN (online) 1365-2796
    ISSN 0954-6820
    DOI 10.1111/joim.13166
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  5. Article: Biopsie cérébrale en réanimation : faisabilité, rentabilité diagnostique, indications et complications/ Safety and diagnostic yield of brain biopsy in critically-ill patients

    Pineton de Chambrun, Marc / Favreau, Malory / Mathon, Bertrand

    Médecine intensive réanimation

    2023  Volume 32, Issue 1, Page(s) 59

    Language French
    Document type Article
    ZDB-ID 2870987-1
    ISSN 2496-6142
    Database Current Contents Medicine

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    Zs.A 4839: Show issues Location:
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  6. Article: Immunomodulating Therapies in Acute Myocarditis and Recurrent/Acute Pericarditis.

    Ammirati, Enrico / Bizzi, Emanuele / Veronese, Giacomo / Groh, Matthieu / Van de Heyning, Caroline M / Lehtonen, Jukka / Pineton de Chambrun, Marc / Cereda, Alberto / Picchi, Chiara / Trotta, Lucia / Moslehi, Javid J / Brucato, Antonio

    Frontiers in medicine

    2022  Volume 9, Page(s) 838564

    Abstract: The field of inflammatory disease of the heart or "cardio-immunology" is rapidly evolving due to the wider use of non-invasive diagnostic tools able to detect and monitor myocardial inflammation. In acute myocarditis, recent data on the use of ... ...

    Abstract The field of inflammatory disease of the heart or "cardio-immunology" is rapidly evolving due to the wider use of non-invasive diagnostic tools able to detect and monitor myocardial inflammation. In acute myocarditis, recent data on the use of immunomodulating therapies have been reported both in the setting of systemic autoimmune disorders and in the setting of isolated forms, especially in patients with specific histology (e.g., eosinophilic myocarditis) or with an arrhythmicburden. A role for immunosuppressive therapies has been also shown in severe cases of coronavirus disease 2019 (COVID-19), a condition that can be associated with cardiac injury and acute myocarditis. Furthermore, ongoing clinical trials are assessing the role of high dosage methylprednisolone in the context of acute myocarditis complicated by heart failure or fulminant presentation or the role of anakinra to treat patients with acute myocarditis excluding patients with hemodynamically unstable conditions. In addition, the explosion of immune-mediated therapies in oncology has introduced new pathophysiological entities, such as immune-checkpoint inhibitor-associated myocarditis and new basic research models to understand the interaction between the cardiac and immune systems. Here we provide a broad overview of evolving areas in cardio-immunology. We summarize the use of new imaging tools in combination with endomyocardial biopsy and laboratory parameters such as high sensitivity troponin to monitor the response to immunomodulating therapies based on recent evidence and clinical experience. Concerning pericarditis, the normal composition of pericardial fluid has been recently elucidated, allowing to assess the actual presence of inflammation; indeed, normal pericardial fluid is rich in nucleated cells, protein, albumin, LDH, at levels consistent with inflammatory exudates in other biological fluids. Importantly, recent findings showed how innate immunity plays a pivotal role in the pathogenesis of recurrent pericarditis with raised C-reactive protein, with inflammasome and IL-1 overproduction as drivers for systemic inflammatory response. In the era of tailored medicine, anti-IL-1 agents such as anakinra and rilonacept have been demonstrated highly effective in patients with recurrent pericarditis associated with an inflammatory phenotype.
    Language English
    Publishing date 2022-03-07
    Publishing country Switzerland
    Document type Systematic Review
    ZDB-ID 2775999-4
    ISSN 2296-858X
    ISSN 2296-858X
    DOI 10.3389/fmed.2022.838564
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  7. 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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  8. Article ; Online: Ceftazidime/avibactam serum concentration in patients on ECMO.

    Curtiaud, Anaïs / Petit, Matthieu / Chommeloux, Juliette / Pineton de Chambrun, Marc / Hekimian, Guillaume / Schmidt, Matthieu / Combes, Alain / Luyt, Charles-Edouard

    The Journal of antimicrobial chemotherapy

    2024  

    Abstract: Objectives: The use of extracorporeal membrane oxygenation (ECMO) may alter blood levels of several drugs, including antibiotics, leading to under dosing of these drugs and thus to potential treatment failure. No data exist on pharmacokinetics of new ... ...

    Abstract Objectives: The use of extracorporeal membrane oxygenation (ECMO) may alter blood levels of several drugs, including antibiotics, leading to under dosing of these drugs and thus to potential treatment failure. No data exist on pharmacokinetics of new antimicrobial, in particular ceftazidime/avibactam. We therefore perform this study to evaluate ceftazidime/avibactam blood levels in ECMO patients and find factors associated with underdosing.
    Methods: Retrospective observational study of patients on ECMO having received ceftazidime/avibactam and in whom trough blood levels of ceftazidime and avibactam were available. Main outcome measurement was the number of patients with ceftazidime and avibactam blood levels above predefined cut-off values, derived from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints for Enterobacteriaceae and Pseudomonas aeruginosa, namely 8 mg/L for ceftazidime and 4 mg/L for avibactam, and explored factors associated with underdosing.
    Results: Twenty-three ceftazidime/avibactam trough levels were available in 14 ECMO patients, all of them having received veno-venous ECMO for SARS-CoV-2-associated pneumonia. Although ceftazidime levels were above 8 mg/L in all except one patient, nine (39%) of the avibactam dosages were below 4 mg/L. Increased renal clearance (creatinine clearance > 130 mL/min) was the main factor associated with under dosing, since 7 out of the 10 dosages below the predefined cut-offs were measured in patients with this condition.
    Conclusions: In ECMO patients receiving ceftazidime/avibactam, ceftazidime and avibactam serum levels are above EUCAST breakpoints in most cases, justifying the use of normal dosing in ECMO patients. Increased renal clearance may lead to ceftazidime and avibactam under dosing.
    Language English
    Publishing date 2024-03-28
    Publishing country England
    Document type Journal Article
    ZDB-ID 191709-2
    ISSN 1460-2091 ; 0305-7453
    ISSN (online) 1460-2091
    ISSN 0305-7453
    DOI 10.1093/jac/dkae091
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    Zs.A 1197: Show issues Location:
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    Zs.MO 124: Show issues

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  9. Article ; Online: A Review and Discussion of Full-Time Equivalency and Appropriate Compensation Models for an Adult Intensivist in the United States Across Various Base Specialties.

    Nurok, Michael / Flynn, Brigid C / Pineton de Chambrun, Marc / Kazemian, Mina / Geiderman, Joel / Nunnally, Mark E

    Critical care explorations

    2024  Volume 6, Issue 4, Page(s) e1064

    Abstract: Objectives: Physicians with training in anesthesiology, emergency medicine, internal medicine, neurology, and surgery may gain board certification in critical care medicine upon completion of fellowship training. These clinicians often only spend a ... ...

    Abstract Objectives: Physicians with training in anesthesiology, emergency medicine, internal medicine, neurology, and surgery may gain board certification in critical care medicine upon completion of fellowship training. These clinicians often only spend a portion of their work effort in the ICU. Other work efforts that benefit an ICU infrastructure, but do not provide billing opportunities, include education, research, and administrative duties. For employed or contracted physicians, there is no singular definition of what constitutes an intensive care full-time equivalent (FTE). Nevertheless, hospitals often consider FTEs in assessing hiring needs, salary, and eligibility for benefits.
    Data sources: Review of existing literature, expert opinion.
    Study selection: Not applicable.
    Data extraction: Not applicable.
    Data synthesis: Not applicable.
    Conclusions: Understanding how an FTE is calculated, and the fraction of an FTE to be assigned to a particular cost center, is therefore important for intensivists of different specialties, as many employment models assign salary and benefits to a base specialty department and not necessarily the ICU.
    Language English
    Publishing date 2024-03-25
    Publishing country United States
    Document type Journal Article
    ISSN 2639-8028
    ISSN (online) 2639-8028
    DOI 10.1097/CCE.0000000000001064
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  10. 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
    Database MEDical Literature Analysis and Retrieval System OnLINE

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