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Article ; Online: Priorisation des patients âgés en réanimation.

Guidet, Bertrand / Bonny, Vincent / Gabarre, Paul / Missri, Louaï / Urbina, Tomas

2022 Volume 72, Issue 2, Page(s) 131–138

Abstract: PRIORISATION OF OLD CRITICALLY-ILL PATIENTS FOR AN ICU ADMISSION There are currently no national or international recommendations for admission decisions to an intensive care unit (icu) for patients over 80 years of age. The decision, whether, or not to ... ...

Title translation	Priorisation of old critically-ill patients for an ICU admission.
Abstract	PRIORISATION OF OLD CRITICALLY-ILL PATIENTS FOR AN ICU ADMISSION There are currently no national or international recommendations for admission decisions to an intensive care unit (icu) for patients over 80 years of age. The decision, whether, or not to admit an elderly patient to intensive care is probably one of the most difficult decisions for an intensivist with the double risk of loss of chance in the event of refusal or non-beneficial care in the event of acceptance. Doubt should always benefit the patient with icu admission in case of prognosis uncertainty. In that case the patient should be reassessed after a few days for tailoring of the level of care. The best criterion for judging the accuracy of decisions is the vital but also the functional prognosis and the long-term expected quality of life for the patient and his relatives. Current and future demographic changes as well as financial constraints justify producing general guidelines in order to ease the decision-making process and reduce practice heterogeneity. The principle of distributive justice must apply in situations of strain on icu bed availability, as in times of a Covid wave.
MeSH term(s)	Aged ; Aged, 80 and over ; COVID-19 ; Critical Illness/therapy ; Humans ; Intensive Care Units ; Patient Admission ; Quality of Life
Language	French
Publishing date	2022-03-15
Publishing country	France
Document type	Journal Article
ZDB-ID	205365-2
ISSN	2101-017X ; 0035-2640
ISSN (online)	2101-017X
ISSN	0035-2640
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Article ; Online: Antineoplastic drug-induced immune hemolytic anemia resulting in acute kidney injury: lesson for the clinical nephrologist.

Bay, Pierre / Buob, David / Modot, Thomas / Gabarre, Paul / Doreille, Alice / Rafat, Cédric

Journal of nephrology

2023 Volume 36, Issue 6, Page(s) 1693–1697

MeSH term(s)	Humans ; Nephrologists ; Anemia, Hemolytic/chemically induced ; Anemia, Hemolytic/diagnosis ; Antineoplastic Agents/adverse effects ; Acute Kidney Injury/chemically induced ; Acute Kidney Injury/diagnosis ; Acute Kidney Injury/drug therapy
Chemical Substances	Antineoplastic Agents
Language	English
Publishing date	2023-04-05
Publishing country	Italy
Document type	Journal Article
ZDB-ID	1093991-x
ISSN	1724-6059 ; 1120-3625 ; 1121-8428
ISSN (online)	1724-6059
ISSN	1120-3625 ; 1121-8428
DOI	10.1007/s40620-023-01600-4
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Zs.A 3369: Show issues

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Article ; Online: Never too late to neutralize botulinum neurotoxin.

Bonny, Vincent / Gabarre, Paul / Urbina, Tomas / Mazuet, Christelle / Missri, Louaï / Joffre, Jérémie / Baudel, Jean-Luc / Ait Oufella, Hafid / Maury, Eric

Minerva anestesiologica

2023 Volume 89, Issue 10, Page(s) 950–951

MeSH term(s)	Humans ; Botulinum Toxins/therapeutic use
Chemical Substances	Botulinum Toxins (EC 3.4.24.69)
Language	English
Publishing date	2023-06-01
Publishing country	Italy
Document type	Case Reports ; Letter
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
DOI	10.23736/S0375-9393.23.17401-3
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Zs.A 516: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 192: Show issues

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Article ; Online: Albumin versus saline infusion for sepsis-related peripheral tissue hypoperfusion: a proof-of-concept prospective study.

Gabarre, Paul / Desnos, Cyrielle / Morin, Alexandra / Missri, Louai / Urbina, Tomas / Bonny, Vincent / Turpin, Matthieu / Baudel, Jean-Luc / Berard, Laurence / Montil, Melissa / Guidet, Bertrand / Voiriot, Guillaume / Joffre, Jérémie / Maury, Eric / Ait-Oufella, Hafid

Critical care (London, England)

2024 Volume 28, Issue 1, Page(s) 43

Abstract: Background: Albumin has potential endothelial protective effects through antioxidant and anti-inflammatory properties. However, the effect of albumin on peripheral tissue perfusion in human sepsis remains poorly known.: Methods: Bi-centric ... ...

Abstract	Background: Albumin has potential endothelial protective effects through antioxidant and anti-inflammatory properties. However, the effect of albumin on peripheral tissue perfusion in human sepsis remains poorly known. Methods: Bi-centric prospective study included patients with sepsis with or without shock and prolonged CRT > 3 s despite initial resuscitation. Clinicians in charge of the patients were free to infuse either saline 500 mL or human serum albumin 20% 100 mL over 15 min. Global hemodynamic parameters as well as peripheral tissue perfusion were analyzed after 1 (H1) and 4 h (H4). The primary endpoint was CRT normalization (< 3 s) at H1. Results: 62 patients were screened, and 50 patients (13 sepsis and 37 septic shock) were included, 21 in the saline group and 29 in the albumin group. SOFA score was 8 [5-11], and SAPS II was 53 [45-70]. Median age was 68 [60-76] years with a higher proportion of men (74%). The primary sources of infection were respiratory (54%) and abdominal (24%). At baseline, comorbidities, clinical and biological characteristics were similar between groups. At H1, CRT normalization (< 3 s) was more frequent in patients receiving albumin as compared to patients treated by saline (63 vs 29%, P = 0.02). The decrease in fingertip CRT was more important in the albumin group when compared to saline group (- 1.0 [- 0.3; - 1.5] vs - 0.2 [- 0.1; - 1.1] seconds, P = 0.04) as well as decrease in mottling score. At H4, beneficial effects of albumin on peripheral tissue perfusion were maintained and urinary output trended to be higher in the albumin group (1.1 [0.5-1.8] vs 0.7 [0.5-0.9] ml/kg/h, P = 0.08). Finally, arterial lactate level did not significantly change between H0 and H4 in the saline group but significantly decreased in the albumin group (P = 0.03). Conclusion: In patients with resuscitated sepsis, albumin infusion might lead to greater improvement of tissue hypoperfusion compared to saline. Clinicaltrials: gov Identifier: NCT05094856.
MeSH term(s)	Humans ; Male ; Aged ; Prospective Studies ; Sepsis/complications ; Sepsis/therapy ; Shock, Septic/complications ; Shock, Septic/drug therapy ; Resuscitation ; Saline Solution ; Albumins/therapeutic use ; Ischemia
Chemical Substances	Saline Solution ; Albumins
Language	English
Publishing date	2024-02-07
Publishing country	England
Document type	Journal Article
ZDB-ID	2041406-7
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/s13054-024-04827-0
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Zs.A 5517: Show issues

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Article ; Online: Immunosuppressive therapy after solid organ transplantation and the gut microbiota: Bidirectional interactions with clinical consequences.

Gabarre, Paul / Loens, Christopher / Tamzali, Yanis / Barrou, Benoit / Jaisser, Frédéric / Tourret, Jérôme

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

2021 Volume 22, Issue 4, Page(s) 1014–1030

Abstract: Our understanding of the involvement of the gut microbiota (GM) in human health has expanded exponentially over the last few decades, particularly in the fields of metabolism, inflammation, and immunology. Immunosuppressive treatment (IST) prescribed to ... ...

Abstract	Our understanding of the involvement of the gut microbiota (GM) in human health has expanded exponentially over the last few decades, particularly in the fields of metabolism, inflammation, and immunology. Immunosuppressive treatment (IST) prescribed to solid organ transplant (SOT) recipients produces GM changes that affect these different processes. This review aims at describing the current knowledge of how IST changes the GM. Overall, SOT followed by IST results in persistent changes in the GM, with a consistent increase in proteobacteria including opportunistic pathobionts. In mice, Tacrolimus induces dysbiosis and metabolic disorders, and alters the intestinal barrier. The transfer of the GM from Tacrolimus-treated hosts confers immunosuppressive properties, suggesting a contributory role for the GM in this drug's efficacy. Steroids induce dysbiosis and intestinal barrier alterations, and also seem to depend partly on the GM for their immunosuppressive and metabolic effects. Mycophenolate Mofetil, frequently responsible for digestive side effects such as diarrhea and colitis, is associated with pro-inflammatory dysbiosis and increased endotoxemia. Alemtuzumab, m-TOR inhibitors, and belatacept have shown more marginal impact on the GM. Most of these observations are descriptive. Future studies should explore the underlying mechanism of IST-induced dysbiosis in order to better understand their efficacy and safety characteristics.
MeSH term(s)	Animals ; Dysbiosis ; Gastrointestinal Microbiome ; Immunosuppression Therapy ; Mice ; Organ Transplantation/adverse effects ; Tacrolimus/pharmacology
Chemical Substances	Tacrolimus (WM0HAQ4WNM)
Language	English
Publishing date	2021-10-15
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2060594-8
ISSN	1600-6143 ; 1600-6135
ISSN (online)	1600-6143
ISSN	1600-6135
DOI	10.1111/ajt.16836
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Zs.A 5542: Show issues

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Article ; Online: Hyperviscosity syndrome.

Dumas, Guillaume / Gabarre, Paul / Bigé, Naike / Maury, Eric

Intensive care medicine

2018 Volume 44, Issue 7, Page(s) 1151–1152

MeSH term(s)	Blood Viscosity ; Hematologic Diseases ; Humans ; Immune System Diseases ; Syndrome
Language	English
Publishing date	2018-02-23
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/s00134-018-5087-y
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Zs.A 1089: Show issues

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Article ; Online: An acute dyspnea.

Gabarre, Paul / Dumas, Guillaume / Duhaut, Léa / Maury, Eric

Intensive care medicine

2018 Volume 44, Issue 8, Page(s) 1326–1328

MeSH term(s)	Acute Disease ; Aged ; Dyspnea/etiology ; Female ; Heart Failure/complications ; Heart Failure/diagnosis ; Humans
Language	English
Publishing date	2018-03-06
Publishing country	United States
Document type	Case Reports ; 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/s00134-018-5103-2
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Zs.A 1089: Show issues

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Article: Case report: Changes in the levels of stress hormones during Takotsubo syndrome.

Ruiz, Pablo / Gabarre, Paul / Chenevier-Gobeaux, Camille / François, Hélène / Kerneis, Mathieu / Cidlowski, John A / Oakley, Robert H / Lefèvre, Guillaume / Boissan, Mathieu

Frontiers in cardiovascular medicine

2022 Volume 9, Page(s) 931054

Abstract: Background: Takotsubo syndrome is an acute cardiac condition usually involving abnormal regional left ventricular wall motion and impaired left ventricular contractility. It is due mainly to hyper-stimulation of the sympathetic nerve system, inducing an ...

Abstract	Background: Takotsubo syndrome is an acute cardiac condition usually involving abnormal regional left ventricular wall motion and impaired left ventricular contractility. It is due mainly to hyper-stimulation of the sympathetic nerve system, inducing an excess of catecholamines, usually triggered by intense psychological or physiological stress. The relationship between Takotsubo syndrome and the circulating stress hormones cortisol and copeptin (a surrogate marker of arginine vasopressin) has not been well documented. Case summary: Here, we describe the dynamic changes in circulating cortisol and copeptin during an entire episode of Takotsubo syndrome in a post-partum woman after spontaneous vaginal delivery. The patient was diagnosed with inverted Takotsubo syndrome accompanied by HELLP syndrome. We found qualitative and quantitative changes in cortisol: a loss of circadian rhythm and a three-fold elevation in the plasma concentration of the hormone with a peak appearing several hours before circulating cardiac biomarkers began to rise. By contrast, levels of copeptin remained normal during the entire episode. Discussion: Our findings indicate that the levels of cortisol change during Takotsubo syndrome whereas those of copeptin do not. This association between elevated cortisol and Takotsubo syndrome suggests that aberrant levels of this stress hormone may contribute to the observed cardiac pathology. We conclude that biochemical assays of circulating cortisol and cardiac biomarkers may be a useful complement to the diagnosis of Takotsubo syndrome by non-invasive cardiac imaging.
Language	English
Publishing date	2022-07-22
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2781496-8
ISSN	2297-055X
ISSN	2297-055X
DOI	10.3389/fcvm.2022.931054
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Article: Prediction of esophagogastroduodenoscopy therapeutic usefulness for in-ICU suspected upper gastrointestinal bleeding: the SUGIBI score study.

Penaud, Victor / Vieille, Thibault / Urbina, Tomas / Bonny, Vincent / Gabarre, Paul / Missri, Louai / Gasperment, Maxime / Baudel, Jean-Luc / Carbonell, Nicolas / Beurton, Alexandra / Chaibi, Sayma / Retbi, Aurélia / Fartoukh, Muriel / Piton, Gaël / Guidet, Bertrand / Maury, Eric / Ait-Oufella, Hafid / Joffre, Jérémie

Annals of intensive care

2024 Volume 14, Issue 1, Page(s) 28

Abstract: Background: Suspected upper gastrointestinal bleeding (SUGIB) is a common issue during ICU stay. In the absence of specific guidelines on the indication and timing of esophagogastroduodenoscopy (EGD), there is substantial variability in EGD indication ... ...

Abstract	Background: Suspected upper gastrointestinal bleeding (SUGIB) is a common issue during ICU stay. In the absence of specific guidelines on the indication and timing of esophagogastroduodenoscopy (EGD), there is substantial variability in EGD indication depending on accessibility and clinical presentation. This study aimed to investigate factors associated with the need for per-EGD hemostatic therapy and to create a score predicting therapeutic benefit of emergency bedside EGD in ICU patients with SUGIB. Methods: We conducted a retrospective study in our ICU to identify factors associated with the need for hemostatic procedure during EGD performed for SUGIB. From this observational cohort, we derived a score predicting the need for hemostasis during EGD, the SUGIBI score. This score was subsequently validated in a retrospective multicenter cohort. Results: Two hundred fifty-five patients not primarily admitted for GI bleeding who underwent a bedside EGD for SUGIB during their ICU stay were analyzed. The preeminent EGD indication were anemia (79%), melena (19%), shock (14%), and hematemesis (13%). EGD was normal in 24.7% of cases, while primary lesions reported were ulcers (23.1%), esophagitis (18.8%), and gastritis (12.5%). Only 12.9% of patients underwent hemostatic endotherapy during EGD. A SUGIBI score < 4 had a negative predictive value of 95% (91-99) for hemostatic endotherapy [AUC of 0.81; 0.75-0.91 (p < 0.0001)]. The SUGIBI score for predicting the need for an EGD-guided hemostatic procedure was next validated in a multicenter cohort with an AUC of 0.75 (0.66-0.85) (p < 0.0001), a score < 4 having a negative predictive value of 95% (92-97). Conclusions: Our study shows that the therapeutic usefulness of bedside emergency EGD for SUGIB in critically ill patients is limited to a minority of patients. The SUGIBI score should help clinicians stratify the probability of a therapeutic EGD.
Language	English
Publishing date	2024-02-15
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2617094-2
ISSN	2110-5820
ISSN	2110-5820
DOI	10.1186/s13613-024-01250-0
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Article ; Online: Corticosteroids induce an early but limited decrease in IL-6 dependent pro-inflammatory responses in critically ill COVID-19 patients.

Urbina, Tomas / Gabarre, Paul / Bonny, Vincent / Lavillegrand, Jean-Rémi / Garnier, Marc / Joffre, Jérémie / Mario, Nathalie / Dumas, Guillaume / Hariri, Geoffroy / Turpin, Matthieu / Pardo, Emmanuel / Fartoukh, Muriel / Guidet, Bertrand / Maury, Eric / Chantran, Yannick / Boelle, Pierre-Yves / Voiriot, Guillaume / Ait-Oufella, Hafid

Minerva anestesiologica

2024 Volume 90, Issue 3, Page(s) 172–180

Abstract: Background: Corticosteroids have become standard of care for COVID-19 but their effect on the systemic immune-inflammatory response has been little investigated.: Methods: Multicenter prospective cohort, including critically ill COVID-19 patients ... ...

Abstract	Background: Corticosteroids have become standard of care for COVID-19 but their effect on the systemic immune-inflammatory response has been little investigated. Methods: Multicenter prospective cohort, including critically ill COVID-19 patients between March and November 2020. C-reactive protein (CRP), lymphocyte count and fibrinogen levels were collected upon hospital admission before initiation of steroid treatment and at ICU admission, three days and seven days later, along with interleukin (IL)-6, IL-10 and tumor necrosis factor-alpha (TNF-α) plasma levels. Results: A hundred and fifty patients were included, 47 received corticosteroids, 103 did not. Median age was 62 [53-70], and 96 (65%) patients were mechanically ventilated. Propensity score matching rendered 45 well-balanced pairs of treated and non-treated patients, particularly on pre-treatment CRP levels. Using a mixed model, CRP (P=0.019), fibrinogen (P=0.003) and lymphocyte counts (P=0.006) remained lower in treated patients over ICU stay. Conversely, there was no significant difference over the ICU stay for Il-6 (P=0.146) and IL-10 (0.301), while TNF- α levels were higher in the treated group (P=0.013). Among corticosteroid-treated patients, CRP (P=0.012), fibrinogen (P=0.041) and lymphocyte count (P=0.004) over time were associated with outcome, whereas plasma cytokine levels were not. Conclusions: Steroid treatment was associated with an early and sustained decrease in the downstream IL-6-dependent inflammatory signature but an increase in TNF-α levels. In corticosteroid-treated patients, CRP and lymphocyte count were associated with outcome, conversely to plasma cytokine levels. Further research on using these biomarker's kinetics to individualize immunomodulatory treatments is warranted.
MeSH term(s)	Humans ; Middle Aged ; Interleukin-6 ; COVID-19 ; Interleukin-10 ; Tumor Necrosis Factor-alpha ; Prospective Studies ; Critical Illness/therapy ; Cytokines ; C-Reactive Protein ; Adrenal Cortex Hormones ; Fibrinogen ; Steroids
Chemical Substances	Interleukin-6 ; Interleukin-10 (130068-27-8) ; Tumor Necrosis Factor-alpha ; Cytokines ; C-Reactive Protein (9007-41-4) ; Adrenal Cortex Hormones ; Fibrinogen (9001-32-5) ; Steroids
Language	English
Publishing date	2024-01-29
Publishing country	Italy
Document type	Multicenter Study ; Journal Article
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
DOI	10.23736/S0375-9393.23.17765-0
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Zs.A 516: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 192: Show issues

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