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Article: One-year outcomes in cardiogenic shock triggered by ventricular arrhythmia: An analysis of the FRENSHOCK multicenter prospective registry.

Cherbi, Miloud / Roubille, François / Lamblin, Nicolas / Bonello, Laurent / Leurent, Guillaume / Levy, Bruno / Elbaz, Meyer / Champion, Sebastien / Lim, Pascal / Schneider, Francis / Cariou, Alain / Khachab, Hadi / Bourenne, Jeremy / Seronde, Marie-France / Schurtz, Guillaume / Harbaoui, Brahim / Vanzetto, Gerald / Quentin, Charlotte / Delabranche, Xavier /

Aissaoui, Nadia / Combaret, Nicolas / Tomasevic, Danka / Marchandot, Benjamin / Lattuca, Benoit / Henry, Patrick / Gerbaud, Edouard / Bonnefoy, Eric / Puymirat, Etienne / Maury, Philippe / Delmas, Clément

Frontiers in cardiovascular medicine

2023 Volume 10, Page(s) 1092904

Abstract: Background: Cardiogenic shock (CS) is a life-threatening condition carrying poor prognosis, potentially triggered by ventricular arrhythmia (VA). Whether the occurrence of VA as trigger of CS worsens the prognosis compared to non-VA triggers remains ... ...

Abstract	Background: Cardiogenic shock (CS) is a life-threatening condition carrying poor prognosis, potentially triggered by ventricular arrhythmia (VA). Whether the occurrence of VA as trigger of CS worsens the prognosis compared to non-VA triggers remains unclear. The aim of this study was to evaluate 1-year outcomes [mortality, heart transplantation, ventricular assist devices (VAD)] between VA-triggered and non-VA-triggered CS. Methods: FRENSHOCK is a prospective multicenter registry including 772 CS patients from 49 centers. One to three triggers can be identified in the registry (ischemic, mechanical complications, ventricular/supraventricular arrhythmia, bradycardia, iatrogenesis, infection, non-compliance). Baseline characteristics, management and 1-year outcomes were analyzed according to the VA-trigger in the CS population. Results: Within 769 CS patients included, 94 were VA-triggered (12.2%) and were compared to others. At 1 year, although there was no mortality difference [42.6 vs. 45.3%, HR 0.94 (0.67-1.30), Conclusion: VA-triggered CS did not show higher mortality compared to other triggers but resulted in more heart transplantation and VAD at 1 year, especially in non-ischemic cardiomyopathy, suggesting the need for earlier evaluation by advanced heart failure specialized team for a possible indication of mechanical circulatory support or heart transplantation. Clinical trial registration: https://clinicaltrials.gov, identifier NCT02703038.
Language	English
Publishing date	2023-01-26
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2781496-8
ISSN	2297-055X
ISSN	2297-055X
DOI	10.3389/fcvm.2023.1092904
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Article ; Online: Characteristics, management, and outcomes of active cancer patients with cardiogenic shock.

Merdji, Hamid / Gantzer, Justine / Bonello, Laurent / Lamblin, Nicolas / Roubille, François / Levy, Bruno / Champion, Sebastien / Lim, Pascal / Schneider, Francis / Cariou, Alain / Khachab, Hadi / Bourenne, Jeremy / Seronde, Marie-France / Schurtz, Guillaume / Harbaoui, Brahim / Vanzetto, Gerald / Quentin, Charlotte / Curtiaud, Anais / Kurtz, Jean-Emmanuel /

Combaret, Nicolas / Marchandot, Benjamin / Lattuca, Benoit / Biendel, Caroline / Leurent, Guillaume / Bataille, Vincent / Gerbaud, Edouard / Puymirat, Etienne / Bonnefoy, Eric / Aissaoui, Nadia / Delmas, Clément

European heart journal. Acute cardiovascular care

2023 Volume 12, Issue 10, Page(s) 682–692

Abstract: Aims: Characteristics, management, and outcomes of patients with active cancer admitted for cardiogenic shock remain largely unknown. This study aimed to address this issue and identify the determinants of 30-day and 1-year mortality in a large ... ...

Abstract	Aims: Characteristics, management, and outcomes of patients with active cancer admitted for cardiogenic shock remain largely unknown. This study aimed to address this issue and identify the determinants of 30-day and 1-year mortality in a large cardiogenic shock cohort of all aetiologies. Methods and results: FRENSHOCK is a prospective multicenter observational registry conducted in French critical care units between April and October 2016. 'Active cancer' was defined as a malignancy diagnosed within the previous weeks with planned or ongoing anticancer therapy. Among the 772 enrolled patients (mean age 65.7 ± 14.9 years; 71.5% male), 51 (6.6%) had active cancer. Among them, the main cancer types were solid cancers (60.8%), and hematological malignancies (27.5%). Solid cancers were mainly urogenital (21.6%), gastrointestinal (15.7%), and lung cancer (9.8%). Medical history, clinical presentation, and baseline echocardiography were almost the same between groups. In-hospital management significantly differed: patients with cancers received more catecholamines or inotropes (norepinephrine 72% vs. 52%, P = 0.005 and norepinephrine-dobutamine combination 64.7% vs. 44.5%, P = 0.005), but had less mechanical circulatory support (5.9% vs. 19.5%, P = 0.016). They presented a similar 30-day mortality rate (29% vs. 26%) but a significantly higher mortality at 1-year (70.6% vs. 45.2%, P < 0.001). In multivariable analysis, active cancer was not associated with 30-day mortality but was significantly associated with 1-year mortality in 30-day survivors [HR 3.61 (1.29-10.11), P = 0.015]. Conclusion: Active cancer patients accounted for almost 7% of all cases of cardiogenic shock. Early mortality was the same regardless of active cancer or not, whereas long-term mortality was significantly increased in patients with active cancer.
MeSH term(s)	Humans ; Male ; Middle Aged ; Aged ; Aged, 80 and over ; Female ; Shock, Cardiogenic/epidemiology ; Shock, Cardiogenic/etiology ; Shock, Cardiogenic/therapy ; Prospective Studies ; Dobutamine/therapeutic use ; Norepinephrine/therapeutic use ; Neoplasms/complications ; Neoplasms/epidemiology
Chemical Substances	Dobutamine (3S12J47372) ; Norepinephrine (X4W3ENH1CV)
Language	English
Publishing date	2023-07-06
Publishing country	England
Document type	Multicenter Study ; Journal Article
ZDB-ID	2663340-1
ISSN	2048-8734 ; 2048-8726
ISSN (online)	2048-8734
ISSN	2048-8726
DOI	10.1093/ehjacc/zuad072
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Article ; Online: Cardiogenic shock in adults with congenital heart disease: Insights from the FRENSHOCK registry.

Karsenty, Clément / Touafchia, Anthony / Ladouceur, Magalie / Roubille, François / Bonnefoy, Eric / Bonello, Laurent / Leurent, Guillaume / Levy, Bruno / Champion, Sébastien / Lim, Pascal / Schneider, Francis / Cariou, Alain / Khachab, Hadi / Bourenne, Jeremy / Seronde, Marie-France / Harbaoui, Brahim / Vanzetto, Gérald / Quentin, Charlotte / Delabranche, Xavier /

Combaret, Nicolas / Morel, Olivier / Lattuca, Benoit / Leborgne, Laurent / Fillippi, Emmanuelle / Gerbaud, Edouard / Brusq, Clara / Bongard, Vanina / Lamblin, Nicolas / Puymirat, Etienne / Delmas, Clément

Archives of cardiovascular diseases

2023 Volume 116, Issue 8-9, Page(s) 390–396

Abstract: Background: Data on cardiogenic shock in adults with congenital heart disease (ACHD) are scarce.: Aim: We sought to describe cardiogenic shock in ACHD patients in a nationwide cardiogenic shock registry.: Methods: From the multicentric FRENSHOCK ... ...

Abstract	Background: Data on cardiogenic shock in adults with congenital heart disease (ACHD) are scarce. Aim: We sought to describe cardiogenic shock in ACHD patients in a nationwide cardiogenic shock registry. Methods: From the multicentric FRENSHOCK registry (772 patients with cardiogenic shock from 49 French centres between April and October 2016), ACHD patients were compared with adults without congenital heart disease (non-ACHD). The primary outcome was defined by all-cause mortality, chronic ventricular assist device or heart transplantation at 1year. Results: Out of the 772 patients, seven (0.9%) were ACHD, who were younger (median age: 56 vs. 67years), had fewer cardiovascular risk factors, such as hypertension (14.3% vs. 47.5%) and diabetes (14.3% vs. 28.3%), and no previous ischaemic cardiopathy (0 vs. 61.5%). Right heart catheterization (57.1% vs. 15.4%), pacemakers (28.6% vs. 4.6%) and implantable cardioverter-defibrillators (28.6% vs. 4.8%) were indicated more frequently in the management of ACHD patients compared with non-ACHD patients, whereas temporary mechanical circulatory support (0 vs. 18.7%) and invasive mechanical ventilation (14.3% vs. 38.1%) were less likely to be used in ACHD patients. At 1year, the primary outcome occurred in 85.7% (95% confidence interval: 42.1-99.6) ACHD patients and 52.3% (95% confidence interval: 48.7-55.9) non-ACHD patients. Although 1-year mortality was not significantly different between ACHD patients (42.9%) and non-ACHD patients (45.4%), ventricular assist devices and heart transplantation tended to be more frequent in the ACHD group. Conclusions: Cardiogenic shock in ACHD patients is rare, accounting for only 0.9% of an unselected cardiogenic shock population. Despite being younger and having fewer co-morbidities, the prognosis of ACHD patients with cardiogenic shock remains severe, and is similar to that of other patients.
MeSH term(s)	Humans ; Adult ; Middle Aged ; Shock, Cardiogenic/diagnosis ; Shock, Cardiogenic/epidemiology ; Shock, Cardiogenic/therapy ; Heart Defects, Congenital/complications ; Heart Defects, Congenital/diagnosis ; Heart Defects, Congenital/epidemiology ; Heart Transplantation/adverse effects ; Heart-Assist Devices/adverse effects ; Registries
Language	English
Publishing date	2023-08-02
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2408778-6
ISSN	1875-2128 ; 1875-2136
ISSN (online)	1875-2128
ISSN	1875-2136
DOI	10.1016/j.acvd.2023.06.008
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Article ; Online: Massive intra-alveolar hemorrhage caused by Leptospira serovar Djasiman in a traveler returning from Laos.

Héry, Guillaume / Letheulle, Julien / Flécher, Erwan / Quentin, Charlotte / Piau, Caroline / Le Tulzo, Yves / Tattevin, Pierre

Journal of travel medicine

2015 Volume 22, Issue 3, Page(s) 212–214

Abstract: Leptospirosis is one of the most common pathogens responsible for life-threatening tropical disease in travelers. We report a case of massive intra-alveolar hemorrhage caused by Leptospira serovar Djasiman in a 38-year-old man returning from Laos, who ... ...

Abstract	Leptospirosis is one of the most common pathogens responsible for life-threatening tropical disease in travelers. We report a case of massive intra-alveolar hemorrhage caused by Leptospira serovar Djasiman in a 38-year-old man returning from Laos, who was cured with antibiotics and salvage treatment with extra-corporeal membrane oxygenation.
MeSH term(s)	Adult ; Amoxicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Hemorrhage/microbiology ; Humans ; Laos ; Leptospira/pathogenicity ; Leptospirosis/complications ; Leptospirosis/drug therapy ; Lung/diagnostic imaging ; Male ; Radiography ; Serogroup ; Travel
Chemical Substances	Anti-Bacterial Agents ; Amoxicillin (804826J2HU)
Language	English
Publishing date	2015-05
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	1212504-0
ISSN	1708-8305 ; 1195-1982
ISSN (online)	1708-8305
ISSN	1195-1982
DOI	10.1111/jtm.12189
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Article ; Online: Hydrocortisone in Severe Community-Acquired Pneumonia.

Dequin, Pierre-François / Meziani, Ferhat / Quenot, Jean-Pierre / Kamel, Toufik / Ricard, Jean-Damien / Badie, Julio / Reignier, Jean / Heming, Nicholas / Plantefève, Gaëtan / Souweine, Bertrand / Voiriot, Guillaume / Colin, Gwenhaël / Frat, Jean-Pierre / Mira, Jean-Paul / Barbarot, Nicolas / François, Bruno / Louis, Guillaume / Gibot, Sébastien / Guitton, Christophe /

Giacardi, Christophe / Hraiech, Sami / Vimeux, Sylvie / L'Her, Erwan / Faure, Henri / Herbrecht, Jean-Etienne / Bouisse, Camille / Joret, Aurélie / Terzi, Nicolas / Gacouin, Arnaud / Quentin, Charlotte / Jourdain, Mercé / Leclerc, Marie / Coffre, Carine / Bourgoin, Hélène / Lengellé, Céline / Caille-Fénérol, Caroline / Giraudeau, Bruno / Le Gouge, Amélie

The New England journal of medicine

2023 Volume 388, Issue 21, Page(s) 1931–1941

Abstract: Background: Whether the antiinflammatory and immunomodulatory effects of glucocorticoids may decrease mortality among patients with severe community-acquired pneumonia is unclear.: Methods: In this phase 3, multicenter, double-blind, randomized, ... ...

Abstract	Background: Whether the antiinflammatory and immunomodulatory effects of glucocorticoids may decrease mortality among patients with severe community-acquired pneumonia is unclear. Methods: In this phase 3, multicenter, double-blind, randomized, controlled trial, we assigned adults who had been admitted to the intensive care unit (ICU) for severe community-acquired pneumonia to receive intravenous hydrocortisone (200 mg daily for either 4 or 7 days as determined by clinical improvement, followed by tapering for a total of 8 or 14 days) or to receive placebo. All the patients received standard therapy, including antibiotics and supportive care. The primary outcome was death at 28 days. Results: A total of 800 patients had undergone randomization when the trial was stopped after the second planned interim analysis. Data from 795 patients were analyzed. By day 28, death had occurred in 25 of 400 patients (6.2%; 95% confidence interval [CI], 3.9 to 8.6) in the hydrocortisone group and in 47 of 395 patients (11.9%; 95% CI, 8.7 to 15.1) in the placebo group (absolute difference, -5.6 percentage points; 95% CI, -9.6 to -1.7; P = 0.006). Among the patients who were not undergoing mechanical ventilation at baseline, endotracheal intubation was performed in 40 of 222 (18.0%) in the hydrocortisone group and in 65 of 220 (29.5%) in the placebo group (hazard ratio, 0.59; 95% CI, 0.40 to 0.86). Among the patients who were not receiving vasopressors at baseline, such therapy was initiated by day 28 in 55 of 359 (15.3%) of the hydrocortisone group and in 86 of 344 (25.0%) in the placebo group (hazard ratio, 0.59; 95% CI, 0.43 to 0.82). The frequencies of hospital-acquired infections and gastrointestinal bleeding were similar in the two groups; patients in the hydrocortisone group received higher daily doses of insulin during the first week of treatment. Conclusions: Among patients with severe community-acquired pneumonia being treated in the ICU, those who received hydrocortisone had a lower risk of death by day 28 than those who received placebo. (Funded by the French Ministry of Health; CAPE COD ClinicalTrials.gov number, NCT02517489.).
MeSH term(s)	Adult ; Humans ; Anti-Inflammatory Agents/adverse effects ; Anti-Inflammatory Agents/therapeutic use ; Community-Acquired Infections/drug therapy ; Community-Acquired Infections/mortality ; Double-Blind Method ; Hydrocortisone/adverse effects ; Hydrocortisone/therapeutic use ; Pneumonia/drug therapy ; Pneumonia/mortality ; Respiration, Artificial ; Treatment Outcome
Chemical Substances	Anti-Inflammatory Agents ; Hydrocortisone (WI4X0X7BPJ)
Language	English
Publishing date	2023-03-21
Publishing country	United States
Document type	Randomized Controlled Trial ; Multicenter Study ; Clinical Trial, Phase III ; Journal Article
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMoa2215145
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Article ; Online: Baseline characteristics, management, and predictors of early mortality in cardiogenic shock: insights from the FRENSHOCK registry.

Delmas, Clement / Roubille, François / Lamblin, Nicolas / Bonello, Laurent / Leurent, Guillaume / Levy, Bruno / Elbaz, Meyer / Danchin, Nicolas / Champion, Sebastien / Lim, Pascal / Schneider, Francis / Cariou, Alain / Khachab, Hadi / Bourenne, Jeremy / Seronde, Marie-France / Schurtz, Guillaume / Harbaoui, Brahim / Vanzetto, Gerald / Quentin, Charlotte /

Delabranche, Xavier / Aissaoui, Nadia / Combaret, Nicolas / Manzo-Silberman, Stephane / Tomasevic, Danka / Marchandot, Benjamin / Lattuca, Benoit / Henry, Patrick / Gerbaud, Edouard / Bonnefoy, Eric / Puymirat, Etienne

ESC heart failure

2021 Volume 9, Issue 1, Page(s) 408–419

Abstract: Aims: Published data on cardiogenic shock (CS) are scarce and are mostly focused on small registries of selected populations. The aim of this study was to examine the current CS picture and define the independent correlates of 30 day mortality in a ... ...

Abstract	Aims: Published data on cardiogenic shock (CS) are scarce and are mostly focused on small registries of selected populations. The aim of this study was to examine the current CS picture and define the independent correlates of 30 day mortality in a large non-selected cohort. Methods and results: FRENSHOCK is a prospective multicentre observational survey conducted in metropolitan French intensive care units and intensive cardiac care units between April and October 2016. There were 772 patients enrolled (mean age 65.7 ± 14.9 years; 71.5% male). Of these patients, 280 (36.3%) had ischaemic CS. Organ replacement therapies (respiratory support, circulatory support or renal replacement therapy) were used in 58.3% of patients. Mortality at 30 days was 26.0% in the overall population (16.7% to 48.0% depending on the main cause and first place of admission). Multivariate analysis showed that six independent factors were associated with a higher 30 day mortality: age [per year, odds ratio (OR) 1.06, 95% confidence interval (CI): 1.04-1.08], diuretics (OR 1.74, 95% CI: 1.05-2.88), circulatory support (OR 1.92, 95% CI: 1.12-3.29), left ventricular ejection fraction <30% (OR 2.15, 95% CI: 1.40-3.29), norepinephrine (OR 2.55, 95% CI: 1.69-3.84), and renal replacement therapy (OR 2.72, 95% CI: 1.65-4-49). Conclusions: Non-ischaemic CS accounted for more than 60% of all cases of CS. CS is still associated with significant but variable short-term mortality according to the cause and first place of admission, despite frequent use of haemodynamic support, and organ replacement therapies.
MeSH term(s)	Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Registries ; Shock, Cardiogenic/etiology ; Stroke Volume ; Ventricular Function, Left
Language	English
Publishing date	2021-12-31
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2814355-3
ISSN	2055-5822 ; 2055-5822
ISSN (online)	2055-5822
ISSN	2055-5822
DOI	10.1002/ehf2.13734
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Article ; Online: Superficial cervical plexus block for transitional analgesia in infratentorial and occipital craniotomy: a randomized trial.

Girard, Francois / Quentin, Charlotte / Charbonneau, Sonia / Ayoub, Christian / Boudreault, Daniel / Chouinard, Philippe / Ruel, Monique / Moumdjian, Robert

Canadian journal of anaesthesia = Journal canadien d'anesthesie

2010 Volume 57, Issue 12, Page(s) 1065–1070

Abstract: Background: In this study, we compared the quality of transitional analgesia provided by bilateral superficial cervical plexus block (SCPB) or morphine following a remifentanil-based anesthesia for infratentorial or occipital craniotomy.: Methods: In ...

Abstract	Background: In this study, we compared the quality of transitional analgesia provided by bilateral superficial cervical plexus block (SCPB) or morphine following a remifentanil-based anesthesia for infratentorial or occipital craniotomy. Methods: In this randomized controlled and double-blind study, 30 patients scheduled for infratentorial or occipital craniotomy were divided randomly into two groups: group morphine (morphine 0.1 mg·kg⁻¹ iv after dural closure and a SCPB performed with 20 mL of 0.9% saline at the end of the surgery) or group block (10 mL of 0.9% saline iv instead of morphine after dural closure and a SCPB performed with 20 mL of a 1:1 mixture of 0.5% bupivacaine and 2% lidocaine at the end of the surgery). Postoperative pain was assessed at one, two, four, eight, 12, 16, and 24 hr using an 11-point (0-10) numerical rating scale (NRS). Analgesia was provided with subcutaneous codeine. Results: Average NRS scores were similar between the two groups at each time interval over the study period. The average scores (with 95% confidence interval) were 3.9 (3.4-4.4) and 4.3 (3.8-4.9) for the block and morphine groups, respectively (P = 0.25). The delay before administration of the first dose of codeine was not statistically different between the two groups: 25 min (5-2,880) vs 21.5 min (5-90), median and range for the block and morphine groups, respectively. The incidence of nausea and vomiting was similar between the two groups. Conclusion: Bilateral superficial cervical plexus block provides transitional analgesia that is clinically equivalent to morphine following remifentanil-based anesthesia in patients undergoing occipital or infratentorial craniotomies.
MeSH term(s)	Adult ; Aged ; Analgesics, Opioid/administration & dosage ; Analgesics, Opioid/adverse effects ; Analgesics, Opioid/therapeutic use ; Anesthetics, Intravenous/administration & dosage ; Anesthetics, Local/administration & dosage ; Bupivacaine/administration & dosage ; Cervical Plexus ; Codeine/administration & dosage ; Codeine/adverse effects ; Codeine/therapeutic use ; Craniotomy/methods ; Double-Blind Method ; Female ; Humans ; Lidocaine/administration & dosage ; Male ; Middle Aged ; Morphine/administration & dosage ; Morphine/adverse effects ; Morphine/therapeutic use ; Nerve Block/methods ; Pain, Postoperative/drug therapy ; Piperidines/administration & dosage ; Time Factors
Chemical Substances	Analgesics, Opioid ; Anesthetics, Intravenous ; Anesthetics, Local ; Piperidines ; Morphine (76I7G6D29C) ; Lidocaine (98PI200987) ; remifentanil (P10582JYYK) ; Codeine (Q830PW7520) ; Bupivacaine (Y8335394RO)
Language	English
Publishing date	2010-12
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Randomized Controlled Trial
ZDB-ID	91002-8
ISSN	1496-8975 ; 0832-610X
ISSN (online)	1496-8975
ISSN	0832-610X
DOI	10.1007/s12630-010-9392-3
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Article ; Online: Serum neuron-specific enolase as predictor of outcome in comatose cardiac-arrest survivors

Prevost Fabrice / Parienti Jean-Jacques / Valette Xavier / Seguin Amélie / Gaillard Cathy / Etard Olivier / Allouche Stéphane / Quentin Charlotte / Daubin Cédric / Ramakers Michel / Terzi Nicolas / Charbonneau Pierre / du Cheyron Damien

BMC Cardiovascular Disorders, Vol 11, Iss 1, p

a prospective cohort study

2011 Volume 48

Abstract: Abstract Background The prediction of neurological outcome in comatose patients after cardiac arrest has major ethical and socioeconomic implications. The purpose of this study was to assess the capability of serum neuron-specific enolase (NSE), a ... ...

Abstract	Abstract Background The prediction of neurological outcome in comatose patients after cardiac arrest has major ethical and socioeconomic implications. The purpose of this study was to assess the capability of serum neuron-specific enolase (NSE), a biomarker of hypoxic brain damage, to predict death or vegetative state in comatose cardiac-arrest survivors. Methods We conducted a prospective observational cohort study in one university hospital and one general hospital Intensive Care Unit (ICU). All consecutive patients who suffered cardiac arrest and were subsequently admitted from June 2007 to February 2009 were considered for inclusion in the study. Patients who died or awoke within the first 48 hours of admission were excluded from the analysis. Patients were followed for 3 months or until death after cardiopulmonary resuscitation. The Cerebral Performance Categories scale (CPC) was used as the outcome measure; a CPC of 4-5 was regarded as a poor outcome, and a CPC of 1-3 a good outcome. Measurement of serum NSE was performed at 24 h and at 72 h after the time of cardiac arrest using an enzyme immunoassay. Clinicians were blinded to NSE results. Results Ninety-seven patients were included. All patients were actively supported during the first days following cardiac arrest. Sixty-five patients (67%) underwent cooling after resuscitation. At 3 months 72 (74%) patients had a poor outcome (CPC 4-5) and 25 (26%) a good outcome (CPC 1-3). The median and Interquartile Range [IQR] levels of NSE at 24 h and at 72 h were significantly higher in patients with poor outcomes: NSE at 24 h: 59.4 ng/mL [37-106] versus 28.8 ng/mL [18-41] ( p < 0.0001); and NSE at 72 h: 129.5 ng/mL [40-247] versus 15.7 ng/mL [12-19] ( p < 0.0001). The Receiver Operator Characteristics (ROC) curve for poor outcome for the highest observed NSE value for each patient determined a cut-off value for NSE of 97 ng/mL to predict a poor neurological outcome with a specificity of 100% [95% CI = 87-100] and a sensitivity of 49% [95% CI = 37-60]. However, an approach based on a combination of SSEPs, NSE and clinical-EEG tests allowed to increase the number of patients (63/72 (88%)) identified as having a poor outcome and for whom intensive treatment could be regarded as futile. Conclusion NSE levels measured early in the course of patient care for those who remained comatose after cardiac arrest were significantly higher in patients with outcomes of death or vegetative state. In addition, we provide a cut-off value for NSE (> 97 ng/mL) with 100% positive predictive value of poor outcome. Nevertheless, for decisions concerning the continuation of treatment in this setting, we emphasize that an approach based on a combination of SSEPs, NSE and clinical EEG would be more accurate for identifying patients with a poor neurological outcome.
Keywords	Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Cardiovascular ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	610 ; 616
Language	English
Publishing date	2011-08-01T00:00:00Z
Publisher	BioMed Central
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Impact of targeted hypothermia in expanded-criteria organ donors on recipient kidney-graft function: study protocol for a multicentre randomised controlled trial (HYPOREME).

Brulé, Noëlle / Canet, Emmanuel / Péré, Morgane / Feuillet, Fanny / Hourmant, Maryvonne / Asehnoune, Karim / Rozec, Bertrand / Duveau, Agnes / Dube, Laurent / Pierrot, Marc / Humbert, Stanislas / Tirot, Patrice / Boyer, Jean-Marc / Martin-Lefevre, Laurent / Labadie, François / Robert, René / Benard, Thierry / Kerforne, Thomas / Thierry, Antoine /

Lesieur, Olivier / Vincent, Jean-François / Lesouhaitier, Mathieu / Larmet, Raphaelle / Vigneau, Cecile / Goepp, Angelique / Bouju, Pierre / Quentin, Charlotte / Egreteau, Pierre-Yves / Huet, Olivier / Renault, Anne / Le Meur, Yannick / Venhard, Jean-Christophe / Buchler, Mathias / Michel, Olivier / Voellmy, Marie-Hélène / Herve, Fabien / Schnell, David / Courte, Anne / Glotz, Denis / Amrouche, Lucile / Hazzan, Marc / Kamar, Nassim / Moal, Valerie / Bourenne, Jeremy / Le Quintrec-Donnette, Moglie / Morelon, Emmanuel / Boulain, Thierry / Grimbert, Philippe / Heng, Anne Elisabeth / Merville, Pierre / Garin, Aude / Hiesse, Christian / Fermier, Brice / Mousson, Christiane / Guyot-Colosio, Charlotte / Bouvier, Nicolas / Rerolle, Jean-Philippe / Durrbach, Antoine / Drouin, Sarah / Caillard, Sophie / Frimat, Luc / Girerd, Sophie / Albano, Laetitia / Rostaing, Lionel / Bertrand, Dominique / Hertig, Alexandre / Westeel, Pierre-Francois / Montini, Florent / Delpierre, Eric / Dorez, Dider / Alamartine, Eric / Ouisse, Carole / Sebille, Veronique / Reignier, Jean

BMJ open

2022 Volume 12, Issue 3, Page(s) e052845

Abstract: Introduction: Expanded-criteria donors (ECDs) are used to reduce the shortage of kidneys for transplantation. However, kidneys from ECDs are associated with an increased risk of delayed graft function (DGF), a risk factor for allograft loss and ... ...

Abstract	Introduction: Expanded-criteria donors (ECDs) are used to reduce the shortage of kidneys for transplantation. However, kidneys from ECDs are associated with an increased risk of delayed graft function (DGF), a risk factor for allograft loss and mortality. HYPOREME will be a multicentre randomised controlled trial (RCT) comparing targeted hypothermia to normothermia in ECDs, in a country where the use of machine perfusion for organ storage is the standard of care. We hypothesise that hypothermia will decrease the incidence of DGF. Methods and analysis: HYPOREME is a multicentre RCT comparing the effect on kidney function in recipients of targeted hypothermia (34°C-35°C) and normothermia (36.5°C-37.5°C) in the ECDs. The temperature intervention starts from randomisation and is maintained until aortic clamping in the operating room. We aim to enrol 289 ECDs in order to analyse the kidney function of 516 recipients in the 53 participating centres. The primary outcome is the occurrence of DGF in kidney recipients, defined as a requirement for renal replacement therapy within 7 days after transplantation (not counting a single session for hyperkalemia during the first 24 hours). Secondary outcomes include the proportion of patients with individual organs transplanted in each group; the number of organs transplanted from each ECD and the vital status and kidney function of the recipients 7 days, 28 days, 3 months and 1 year after transplantation. An interim analysis is planned after the enrolment of 258 kidney recipients. Ethics and dissemination: The trial was approved by the ethics committee of the French Intensive Care Society (CE-SRLF-16-07) on 26 April 2016 and by the competent French authorities on 20 April 2016 (Comité de Protection des Personnes-TOURS-Région Centre-Ouest 1, registration #2016-S3). Findings will be published in peer-reviewed journals and presented during national and international scientific meetings. Trial registration number: NCT03098706.
MeSH term(s)	Graft Survival ; Humans ; Hypothermia/etiology ; Kidney ; Kidney Transplantation/adverse effects ; Multicenter Studies as Topic ; Randomized Controlled Trials as Topic ; Tissue Donors ; Transplants
Language	English
Publishing date	2022-03-28
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2021-052845
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: A comparison of two doses of mannitol on brain relaxation during supratentorial brain tumor craniotomy: a randomized trial.

Quentin, Charlotte / Charbonneau, Sonia / Moumdjian, Robert / Lallo, Alexandre / Bouthilier, Alain / Fournier-Gosselin, Marie-Pierre / Bojanowski, Michel / Ruel, Monique / Sylvestre, Marie-Pierre / Girard, Francois

Anesthesia and analgesia

2013 Volume 116, Issue 4, Page(s) 862–868

Abstract: Background: Twenty percent mannitol is widely used to reduce brain bulk and facilitate the surgical approach in intracranial surgery. However, a dose-response relationship has not yet been established. In this study, we compared the effects of 0.7 and 1. ...

Abstract	Background: Twenty percent mannitol is widely used to reduce brain bulk and facilitate the surgical approach in intracranial surgery. However, a dose-response relationship has not yet been established. In this study, we compared the effects of 0.7 and 1.4 g·kg(-1) mannitol on brain relaxation during elective supratentorial brain tumor surgery. Methods: In this prospective, randomized, double-blind study, we enrolled 80 patients undergoing supratentorial craniotomy for tumor resection. Patients were assigned to receive 0.7 g·kg(-1) (group L) or 1.4 g·kg(-1) (group H) of 20% mannitol at surgical incision. Brain relaxation was assessed immediately after opening of the dura on a scale ranging from 1 to 4 (1 = perfectly relaxed, 2 = satisfactorily relaxed, 3 = firm brain, 4 = bulging brain). Results: There was no significant difference between the 2 groups regarding age, sex, body mass index, and brain tumor localization or size. In group L 52.5% of patients and in group H 77.5% of patients presented a midline shift (P = 0.03). The median scores of brain relaxation (interquantile range) were 2.0 (1.75-3) and 2.0 (1-3) (P = 0.16 for patients in group L and H, respectively). We then used a proportional odds model to adjust for this unbalanced distribution and to assess the group effect (low-dose versus high-dose mannitol) on brain relaxation scores. When adjusted for the presence of midline shift, the use of a higher dose of mannitol resulted in an odds ratio of 2.5 (P = 0.03). This indicates that, considering the effect of a midline shift, the odds of having a 1-level improvement in relaxation score in patients who received a higher dose of mannitol (group H) was 2.5 times as large as the odds for the low-dose group. The odds ratio of 0.29 (P = 0.007) for the midline shift indicates that its occurrence was associated with a higher probability of a lower relaxation score, on average. Conclusion: In this study, we show that 1.4 g·kg(-1) of 20% mannitol results in equivalent brain relaxation scores as 0.7 g·kg(-1) in patients undergoing craniotomy for supratentorial brain tumor. When corrected for the presence of midline shift, this study reveals that patients in the high-dose group had significantly more chances of obtaining a better relaxation score compared with the lower-dose group.
MeSH term(s)	Aged ; Anesthesia, General ; Blood Gas Analysis ; Brain/drug effects ; Brain Neoplasms/pathology ; Brain Neoplasms/surgery ; Craniotomy/methods ; Diuretics/administration & dosage ; Diuretics/pharmacology ; Electrolytes/metabolism ; Female ; Hemodynamics/drug effects ; Humans ; Intracranial Pressure/drug effects ; Male ; Mannitol/administration & dosage ; Mannitol/pharmacology ; Middle Aged ; Neurosurgical Procedures/methods ; Osmolar Concentration ; Sample Size ; Supratentorial Neoplasms/pathology ; Supratentorial Neoplasms/surgery ; Treatment Outcome
Chemical Substances	Diuretics ; Electrolytes ; Mannitol (3OWL53L36A)
Language	English
Publishing date	2013-04
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0b013e318282dc70
Database	MEDical Literature Analysis and Retrieval System OnLINE

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