Publications by authors named "Charles Edouard Luyt"
Multisystem inflammatory syndrome in children (MIS-C) is a rare condition following SARS-CoV-2 infection associated with intestinal manifestations. Genetic predisposition, including inborn errors of the OAS-RNAseL pathway, has been reported. We sequenced 154 MIS-C patients and utilized a novel statistical framework of gene burden analysis, "burdenMC," which identified an enrichment for rare predicted-deleterious variants in BTNL8 (OR = 4.
View Article and Find Full Text PDFSimilar Kinetics of Pulmonary SARS-CoV-2 Load in Intensive Care Unit Patients with COVID-19 Pneumonia with or Without Autoantibodies Neutralizing Type I Interferons.
Valentine Le Stang Paul Bastard Elise Langouet Marc Pineton de Chambrun Juliette Chommeloux Charles-Edouard Luyt
J Clin Immunol
November 2024
Purpose: The pathogenesis of life-threatening coronavirus disease 2019 (COVID-19) pneumonia in ICU patients can involve pre-existing auto-antibodies (auto-Abs) neutralizing type I interferons (IFNs). The impact of these auto-Abs on SARS-CoV-2 clearance in the lower respiratory tract (LRT) is unclear.
Methods: We performed a retrospective study in 99 ICU patients with COVID-19 pneumonia between March and May 2020.
Purpose: Fever is frequent after extracorporeal membrane oxygenation (ECMO) decannulation. We aimed to evaluate the incidence of post-decannulation fever and describe its causes.
Methods: Adult ECMO patients who were successfully weaned from ECMO were retrospectively included.
Objectives: Vascular complications after venoarterial extracorporeal membrane oxygenation (ECMO) remains poorly studied, although they may highly impact patient management after ECMO removal. Our aim was to assess their frequency, predictors, and management.
Design: Retrospective, observational cohort study.
Article Synopsis
- This study examines the effectiveness of switching patients from peripheral veno-arterial ECMO (pECMO) to central ECMO (cECMO) as a treatment strategy for refractory cardiogenic shock (rCS).
- Out of 80 patients analyzed, only 38% were successfully bridged to recovery, heart transplantation, or a ventricle assist device, while the remaining 62% died during cECMO treatment.
- Complications were common, with high rates of renal issues and bleeding, and the study found that myocardial infarction significantly increased the risk of in-hospital mortality.
Article Synopsis
- Researchers conducted a 7-year study in France and Italy to investigate the best timing and methods for weaning patients from venovenous ECMO (VV ECMO) after severe ARDS.
- The study analyzed 393 patients, comparing those who were weaned from controlled ventilation versus spontaneous breathing, but found no significant differences in their 90-day successful weaning rates.
- The study concluded that factors like age and existing health issues had a greater impact on weaning success than the ventilation strategy used during ECMO, indicating a need for more research in this area.
Article Synopsis
- The review outlines challenges in treating difficult-to-treat strains of Stenotrophomonas maltophilia (Sma), particularly those resistant to standard antibiotics like trimethoprim-sulfamethoxazole and fluoroquinolones.
- Recent findings indicate that current antibiotic breakpoints may underestimate the prevalence of these resistant strains, highlighting the need for better treatment strategies.
- While cefiderocol and an aztreonam-L2 inhibitor combination show promise, their clinical efficacy is still uncertain, and further comparative studies are essential to guide treatment decisions effectively.*
Article Synopsis
- Severe thrombotic antiphospholipid syndrome (APS) significantly affects critical organs and has not been thoroughly studied in ICU patients, particularly regarding hematological issues.
- A retrospective study in France tracked 134 APS patients in ICUs, revealing high rates of anemia (95%) and thrombocytopenia (93%), with low platelet counts linked to increased mortality.
- The findings highlight the importance of understanding the causes of thrombocytopenia in APS patients, as conditions like thrombotic microangiopathy (TMA), heparin-induced thrombocytopenia (HIT), and disseminated intravascular coagulation (DIC) are prevalent in this population.
Article Synopsis
- High-risk pulmonary embolism (PE) patients can experience hemodynamic instability despite treatment; VA-ECMO is explored as a life-saving intervention, but pre-treatment with systemic thrombolysis poses risks of bleeding.
- A study covering 72 patients assessed ECMO complications and survival rates, revealing similar 90-day survival rates and bleeding incidents between those treated with systemic thrombolysis and those without.
- Long-term quality of life for survivors was found to be acceptable, indicating that recent systemic thrombolysis shouldn't be deemed a contraindication for VA-ECMO in high-risk PE cases.
Background: The COVID-19 pandemic has highlighted the importance of intensive care units (ICUs) and their organization in healthcare systems. However, ICU capacity and availability are ongoing concerns beyond the pandemic, particularly due to an aging population and increasing complexity of care. This study aimed to assess the current and future shortage of ICU physicians in France, ten years after a previous evaluation.
View Article and Find Full Text PDFArticle Synopsis
- Right ventricular failure (RVF) is a critical issue leading to high mortality rates shortly after heart transplantation, and the study explores how isoproterenol (Iso) can help improve heart function in these patients.
- A retrospective study over one year evaluated the hemodynamic effects of Iso in 25 patients with early RVF, comparing no Iso treatment to low and high doses of Iso.
- Results showed that Iso significantly increased heart rate and cardiac index, indicating improved heart function, while its effects on pulmonary pressures were minimal, highlighting its potential as a beneficial treatment for RVF post-heart transplant.
Article Synopsis
- The study examines the recurrence of ventilator-associated pneumonia (VAP) in patients with severe COVID-19 treated with ECMO, highlighting how common VAP recurrence is among this group.
- Out of 210 patients who developed initial VAP, 82% experienced a recurrence, typically within 10 days, predominantly caused by Enterobacteriaceae and Pseudomonas aeruginosa.
- The duration of antibiotic treatment for the first episode (short course <8 days vs. prolonged course ≥8 days) did not significantly impact the likelihood of VAP recurrence.
Article Synopsis
- Patients with COVID-19 requiring mechanical ventilation have a high risk of developing ventilator-associated pneumonia (VAP), particularly caused by Enterobacterales, with limited data on extended-spectrum beta-lactamase producing Enterobacterales (ESBL-E).
- In a study involving 591 patients with Enterobacterales related VAP, 19% developed ESBL-E infections, primarily from Enterobacter sp, K. pneumoniae, and E. coli, while a very small percentage experienced carbapenem-resistant Enterobacterales (CRE) infections.
- Key risk factors for ESBL-E related VAP included African origin, time between intubation and VAP development, the patient's oxygenation status, and prior exposure to trimethopr
Article Synopsis
- The study investigates how extracorporeal membrane oxygenation (ECMO) affects blood levels of the antibiotic combination ceftazidime/avibactam, as altered drug levels can lead to treatment failures.
- A retrospective analysis of 14 ECMO patients showed that while most had adequate ceftazidime levels, 39% had insufficient avibactam levels, particularly in patients with increased renal clearance.
- The findings indicate that normal dosing of ceftazidime/avibactam is generally effective in ECMO patients, but that higher renal clearance can cause under dosing, highlighting the need for monitoring in these cases.
Article Synopsis
- Management of dual antiplatelet therapy (DAPT) in VA-ECMO patients post-acute myocardial infarction (AMI) presents challenges, with significant occurrences of severe bleeding and coagulation issues.
- A study analyzed 176 post-AMI patients on VA-ECMO, finding nearly 39% experienced severe bleeding and a high mortality rate of 49%.
- Factors such as female sex, duration on ECMO, and certain biomarkers were linked to an increased risk of severe bleeding, which led to the discontinuation of antiplatelet therapy in one-third of the cases.
Article Synopsis
- The study investigates how increasing the sweep gas flow in venoarterial ECMO patients with cardiogenic shock affects dyspnea.
- Nonintubated patients with significant dyspnea were assessed while sweep gas flow was increased, showing a marked reduction in dyspnea levels.
- Results indicated that higher sweep gas flow led to significant decreases in both the sensory and emotional aspects of dyspnea and reduced respiratory muscle activity, suggesting a strong relationship between gas flow and dyspnea relief.
Article Synopsis
- Immunocompromised patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) exhibit high mortality rates, with 70% dying within 90 days and 75% within a year.
- Factors contributing to these outcomes include older age and elevated pre-ECMO lactate levels, indicating higher risk.
- The study highlights severe complications such as hemorrhages and infections, with immunocompromised individuals having twice the risk of 90-day mortality compared to non-immunocompromised patients.
Article Synopsis
- Ventilator associated pneumonia (VAP) caused by wild-type AmpC-producing Enterobacterales is common in ICU patients, and the study explores the effectiveness of different antimicrobial therapies (AMT), specifically piperacillin ± tazobactam (PTZ) and third-generation cephalosporins (3GCs).
- In a study involving 274 ICU patients, no significant differences in treatment success at day 7 were found between the groups receiving PTZ, 3GCs, or other control treatments, with all groups showing success rates around 68-74%.
- However, patients treated with 3GCs had a higher likelihood of pneumonia recurrence by day 28 compared to those on PTZ
Article Synopsis
- - Legionnaires' disease (LD) is a serious infection particularly affecting solid organ transplant recipients, though details about its impact on this group have not been well documented.
- - A 10-year study in France identified 101 patients with LD among transplant recipients, finding that severe cases were linked to factors like negative urinary antigen tests and respiratory symptoms.
- - Key imaging results showed significant lung involvement, and the study reported a 30-day mortality rate of 8% and a 12-month mortality rate of 20% among these patients.
Purpose: Lower respiratory tract infections (LRTI) are the most frequent infectious complication in patients admitted to the intensive care unit (ICU). We aim to report the clinical characteristics of ICU-admitted patients due to nosocomial LRTI and to describe their microbiology and clinical outcomes.
Methods: A prospective observational study was conducted in 13 countries over two continents from 9th May 2016 until 16th August 2019.
Diagnostic yield, safety and therapeutic consequences of myocardial biopsy in clinically suspected fulminant myocarditis unweanable from mechanical circulatory support.
Yann Marquet Guillaume Hékimian Guillaume Lebreton Mathieu Kerneis Philippe Rouvier Charles-Edouard Luyt
Ann Intensive Care
August 2023
Article Synopsis
- Fulminant myocarditis is a serious condition that requires accurate diagnosis, typically through a myocardial biopsy, but the procedure carries risks, and its effectiveness for treatment is unclear.
- A study at a French ICU examined patients who were on mechanical circulatory support (MCS) and underwent biopsy, finding that while the diagnosis of definite myocarditis increased significantly after biopsy, the actual change in treatment was minimal.
- The study concluded that the risks associated with myocardial biopsy may outweigh its benefits in these vulnerable patients, suggesting a need for more caution in deciding to perform the procedure.
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.