Publications by authors named "Asfar P"
Article Synopsis
- The study aimed to determine if setting a lower mean arterial blood pressure (MAP) target could reduce 90-day all-cause mortality in critically ill patients with vasodilatory shock compared to a higher MAP target.
- Researchers performed a meta-analysis of randomized controlled trials involving 3,352 patients across several countries, using statistical models to analyze the data.
- The results suggested that a lower MAP target might be associated with a slight reduction in mortality risk, but the evidence is uncertain, indicating that it does not rule out the possibility of potential harm from lower targets.
Severe acute respiratory syndrome (SARS) and acute respiratory distress syndrome (ARDS) are often considered separate clinico-radiological entities. Whether these conditions also present a single process-specific systemic biomolecular phenotype and how this relates to patient outcomes remains unknown. A prospective cohort study was conducted, including adult patients admitted to the ICU and general floors for COVID-19-related (COVID+) or non-COVID-19-related (COVID-) acute respiratory failure during the main phase of the pandemic.
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- Researchers investigated the effect of losartan, an angiotensin receptor blocker, on 28-day mortality in hospitalized COVID-19 patients compared to usual care, due to its potential impact on angiotensin levels.
- The study was stopped early due to safety concerns, showing that adverse events and hypotension were significantly higher in the losartan group (39.8% SAEs and 30.4% hypotension) versus the control group (27.2% SAEs and 15.3% hypotension).
- There was no significant difference in 28-day mortality (6.5% for losartan vs. 5.9% for usual care), indicating that ARBs should be used cautiously in this patient population to
Article Synopsis
- Endotracheal intubation (ETI) is crucial for critically ill patients
- , but it has risks like hypoxemia; preoxygenation is used to enhance safety but can have unreliable monitoring through standard pulse oximeters (SpO2).
- The Oxygen Reserve Index (ORI)
- is proposed as a more reliable continuous measure during preoxygenation, targeting an ORI value of at least 0.6 over one minute instead of the standard SpO2 100% goal to improve outcomes.
- A trial with 950 critically ill adults
- will compare ORI monitoring against standard SpO2 monitoring during ETI; outcomes include the lowest SpO2 during intubation and cognitive
Background: Critical-illness survivors may experience post-traumatic stress disorder (PTSD) and quality-of-life impairments. Resilience may protect against psychological trauma but has not been adequately studied after critical illness. We assessed resilience and its associations with PTSD and quality of life, and also identified factors associated with greater resilience.
View Article and Find Full Text PDFEpidemiological data suggest that moderate hyperoxemia may be associated with an improved outcome after traumatic brain injury. In a prospective, randomized investigation of long-term, resuscitated acute subdural hematoma plus hemorrhagic shock (ASDH + HS) in 14 adult, human-sized pigs, targeted hyperoxemia (200 < PO < 250 mmHg vs. normoxemia 80 < PO < 120 mmHg) coincided with improved neurological function.
View Article and Find Full Text PDFIntroduction: Supplementation with increased inspired oxygen fractions has been suggested to alleviate the harmful effects of tissue hypoxia during hemorrhagic shock (HS) and traumatic brain injury. However, the utility of therapeutic hyperoxia in critical care is disputed to this day as controversial evidence is available regarding its efficacy. Furthermore, in contrast to its hypoxic counterpart, the effect of hyperoxia on the metabolism of circulating immune cells remains ambiguous.
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- The SEPSISCOOL II trial aims to determine if actively cooling fevered patients in septic shock improves survival and organ function compared to not treating the fever.
- It is a multicenter, randomized controlled trial involving 820 patients admitted to intensive care units, with the primary endpoint being mortality at day 60.
- Funded by the French health ministry and approved by an ethics committee, the findings will be shared in peer-reviewed journals upon completion.
Introduction: Current guidelines on clinical nutrition of ventilated patients in the intensive care unit (ICU) recommend initiating continuous enteral nutrition within 48 hours of ICU admission when feasible. However, discontinuous feeding regimens, alternating feeding and fasting intervals, may have an impact on clinical and patient centred outcomes. The ongoing "Impact of daily cyclic enteral nutrition versus standard continuous enteral nutrition in critically ill patients" (DC-SCENIC) trial aims to compare standard continuous enteral feeding with daily cyclic enteral feeding over 10 hours to evaluate if implementing a fasting-mimicking diet can decrease organ failure in ventilated patients during the acute phase of ICU management.
View Article and Find Full Text PDFBackground: Recent studies identified coronavirus disease 2019 (COVID-19) as a risk factor for invasive pulmonary aspergillosis (IPA) but produced conflicting data on IPA incidence and impact on patient outcomes. We aimed to determine the incidence and outcomes of COVID-19-associated pulmonary aspergillosis (CAPA) in mechanically ventilated patients.
Methods: We performed a multicenter retrospective observational cohort study in consecutive adults admitted to 15 French intensive care units (ICUs) in 2020 for COVID-19 requiring mechanical ventilation.
Article Synopsis
- International guidelines suggest keeping body temperature below 37.8 °C for unconscious patients after out-of-hospital cardiac arrest (OHCA), but targeting 33 °C may yield better results for patients with a nonshockable rhythm.
- The study aimed to determine if inducing hypothermia at 33 °C leads to higher survival rates and better functional outcomes compared to maintaining normal body temperature (normothermia).
- Data was gathered from two clinical trials involving unconscious OHCA patients with nonshockable rhythms, comparing those treated with hypothermia versus normothermia for a minimum of 24 hours, analyzing various factors influencing outcomes.*
Article Synopsis
- Out-of-hospital cardiac arrest (OHCA) varies in cause and prognosis, prompting a study to assess the effectiveness of the Cardiac Arrest Prognosis (CAHP) Score compared to traditional methods (Utstein style criteria) for predicting patient outcomes.
- The study collected data from 24 ICUs in France and Belgium on comatose patients with OHCA who had a stable return of spontaneous circulation, aiming to evaluate various predictive scores and their accuracy in anticipating neurological outcomes after 90 days.
- Among the 658 patients analyzed, results showed a 63% mortality rate and noted that while Utstein criteria had moderate predictive capability (AUROC of 0.79), other scores demonstrated a range of performance, with some showing
Background: Restoring plasma arginine levels through enteral administration of L-citrulline in critically ill patients may improve outcomes. We aimed to evaluate whether enteral L-citrulline administration reduced organ dysfunction based on the Sequential Organ Failure Assessment (SOFA) score and affected selected immune parameters in mechanically ventilated medical intensive care unit (ICU) patients.
Methods: A randomized, double-blind, multicenter clinical trial of enteral administration of L-citrulline versus placebo for critically ill adult patients under invasive mechanical ventilation without sepsis or septic shock was conducted in four ICUs in France between September 2016 and February 2019.
Background: Response to prophylactic platelet transfusion is suspected to be inconsistent in critically ill patients questioning how to optimize transfusion practices. This study aimed to describe prophylactic platelet transfusion response, to identify factors associated with a suboptimal response, to analyse the correlation between corrected count increment and platelet count increment and to determine the association between poor platelet transfusion response and clinical outcomes.
Methods: This prospective multicentre observational study recruited patients who received at least one prophylactic platelet transfusion in one of the nine participating intensive care units for a period up to 16 months.
Background: Except in a few retrospective studies mainly including patients under chemotherapy, information regarding the impact of immunosuppressive therapy on the prognosis of patients admitted to the intensive care unit (ICU) for septic shock is scarce. Accordingly, the PACIFIC study aimed to asses if immunosuppressive therapy is associated with an increased mortality in patients admitted to the ICU for septic shock.
Methods: This was a retrospective epidemiological multicentre study.
Article Synopsis
- Vascular leakage is a key issue in ARDS, especially in COVID-19 patients, and the study aimed to test FX06, a drug meant to stabilize blood vessel junctions, for its effectiveness in reducing this leakage.
- In a double-blinded trial with 49 adults on mechanical ventilation, participants received either FX06 or a placebo, but results showed no difference in lung-water levels or other key measures between the two groups after 7 days.
- Although FX06 did not reduce vascular leakage, it was associated with a higher incidence of ventilator-associated pneumonia, indicating the need for further studies to assess its timing and dosing for better results.
Objectives: To determine the feasibility, safety, and efficacy of a biomarker-guided implementation of a kidney-sparing sepsis bundle (KSSB) of care in comparison with standard of care (SOC) on clinical outcomes in patients with sepsis.
Design: Adaptive, multicenter, randomized clinical trial.
Setting: Five University Hospitals in Europe and North America.
Background: Activation of the TREM-1 pathway is associated with outcome in life threatening COVID-19. Data suggest that modulation of this pathway with nangibotide, a TREM-1 modulator may improve survival in TREM-1 activated patients (identified using the biomarker sTREM-1).
Methods: Phase 2 double-blind randomized controlled trial assessing efficacy, safety, and optimum treatment population of nangibotide (1.
Article Synopsis
- Extracellular histones released during cell death contribute to inflammation and cell death, especially in sepsis, highlighting their harmful effects.
- Clusterin (CLU) is an extracellular protein that may counteract the adverse effects of histones by binding to them and neutralizing their harmful properties.
- In sepsis patients, lower CLU levels correlate with increased mortality, and studies show that CLU supplementation can enhance survival rates in mouse models of sepsis.
Article Synopsis
- Patients with severe COVID-19 in ICUs have a high risk of blood clots, prompting a study to compare the effects of intermediate-dose versus standard-dose anticoagulation.
- The study included 1,174 patients and found no significant difference in 90-day mortality or ICU stay length between the two dosing groups, but intermediate-dose patients had fewer venous thrombo-embolism (VTE) incidents.
- Both groups experienced similar rates of bleeding complications, indicating that while the doses impacted blood clot rates, they did not affect overall survival or safety.
Article Synopsis
- A study called the NUTRIREA-3 trial explored whether lower calorie and protein intake during the early treatment of critically ill patients could lead to better outcomes compared to standard nutrition guidelines.
- Conducted in 61 ICUs across France, the trial involved over 3,000 patients who received either low or standard nutrition after being put on mechanical ventilation for shock.
- Results showed no significant difference in 90-day mortality rates but indicated that patients on the low nutrition plan had a slightly quicker ICU discharge time and experienced fewer gastrointestinal issues and liver dysfunction.
During hemorrhagic shock, blood loss causes a fall in blood pressure, decreases cardiac output, and, consequently, O transport. The current guidelines recommend the administration of vasopressors in addition to fluids to maintain arterial pressure when life-threatening hypotension occurs in order to prevent the risk of organ failure, especially acute kidney injury. However, different vasopressors exert variable effects on the kidney, depending on the nature and dose of the substance chosen as follows: Norepinephrine increases mean arterial pressure both via its α-1-mediated vasoconstriction leading to increased systemic vascular resistance and its β1-related increase in cardiac output.
View Article and Find Full Text PDFBackground: Generalised convulsive status epilepticus (GCSE) is a medical emergency. Guidelines recommend a stepwise strategy of benzodiazepines followed by a second-line anti-seizure medicine (ASM). However, GCSE is uncontrolled in 20-40% patients and is associated with protracted hospitalisation, disability, and mortality.
View Article and Find Full Text PDFObjectives: Balancing the risks of hypotension and vasopressor-associated adverse effects is a daily challenge in ICUs. We conducted a systematic review with meta-analysis to examine the effect of lower versus higher exposure to vasopressor therapy on mortality among adult ICU patients with vasodilatory hypotension.
Data Sources: We searched Ovid Medline, Embase, and the Cochrane Central Register of Controlled Trials for studies published from inception to October 15, 2021.
Background: Dexamethasone is recommended for COVID-19 patients who require oxygen therapy. However, its effectiveness in reducing mortality and intubation, and its safety, remain debated. We aimed to investigate whether dexamethasone reduces day-28 mortality in unselected patients with critical COVID-19.
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