Publications by authors named "Etienne Gayat"

Background: Due to their invasiveness, arterial lines are not typically used in routine monitoring, despite their superior responsiveness in hemodynamic monitoring and detecting intraoperative hypotension. To address this issue, noninvasive, continuous arterial pressure monitoring is necessary. We developed a deep-learning model that reconstructs continuous mean arterial pressure (MAP) using the photoplethysmograhy (PPG) signal and compared it to the arterial line gold standard.

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Objective: Mean arterial pressure is widely used as the variable to monitor during anesthesia. But there are many other variables proposed to define intraoperative arterial hypotension. The goal of the present study was to search arterial pressure variables linked with prolonged postoperative length of stay (pLOS).

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  • - Anemia is a common issue among heart failure patients, affecting their treatment outcomes, and this study aimed to examine how anemia prevalence changes and its relationship with clinical results in heart failure patients from the STRONG-HF study.
  • - In the study of 1077 patients, anemia rates rose from 27.2% at enrollment to 32.1% at 90 days, with a slightly higher primary composite outcome observed in anemic patients, but the difference wasn't statistically significant.
  • - Patients with baseline anemia showed less improvement in health-related quality of life, while the incidence of anemia was higher in those receiving high-intensity care compared to usual care; factors like male sex and non-European regions were linked to a higher
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  • * Conducted across 40 hospitals in France, the trial involved 2,222 patients who were randomly assigned to either keep using RASIs until surgery or stop them 48 hours prior.
  • * The results showed no significant difference in all-cause mortality or major complications within 28 days after surgery between the two groups, suggesting that either strategy can be safely applied.
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Introduction: Awake surgery is now a common approach for the resection of glioma. One of the surgical complications is mini-stroke which take the form of periresectional small areas of brain ischemic lesions. The main objective of this study is to evaluate the association between factors related to anesthetic management and the risk of mini-stroke, in awake surgery for glioma resection.

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Aims: Intraoperative hypotension is a risk factor for kidney, heart and cognitive postoperative complications. Literature suggests that the use of low-dose peripheral norepinephrine (NOR) reduces organ dysfunction, yet its administration remains unstandardized. In this work we develop a pharmacokinetic (PK)/pharmacodynamic (PD) model of NOR and its effect on mean arterial pressure (MAP).

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  • The STRONG-HF trial tested the effectiveness of rapidly increasing neurohormonal blockade in patients with acute heart failure (AHF) compared to usual care.
  • Patients receiving high-intensity care (HIC) showed significantly higher rates of successful decongestion at day 90 (75%) compared to usual care (68%), alongside improvements in various decongestion markers.
  • Successful decongestion was linked to a lower risk of hospital readmission or all-cause death, indicating that the HIC approach offers better long-term outcomes for AHF patients.
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Background: Perioperative renal and myocardial protection primarily depends on preoperative prediction tools, along with intraoperative optimization of cardiac output (CO) and mean arterial pressure (MAP). We hypothesise that monitoring the intraoperative global afterload angle (GALA), a proxy of ventricular afterload derived from the velocity pressure (VP) loop, could better predict changes in postoperative biomarkers than the recommended traditional MAP and CO.

Method: This retrospective monocentric study included patients programmed for neurosurgery with continuous VP loop monitoring.

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  • - Biologically active adrenomedullin (bio-ADM) has potential as a marker for residual congestion in heart failure (HF) patients, as shown in the STRONG-HF trial, which indicated that high-intensity care of guideline-directed medical therapy can improve patient outcomes.
  • - A study measuring bio-ADM levels in 1,005 heart failure patients found that higher baseline bio-ADM concentrations were linked to increased risks of mortality and rehospitalization, while bio-ADM changes correlated with congestion status after 90 days.
  • - Although bio-ADM showed modest predictive ability for patient outcomes, the study found that high-intensity care improved outcomes regardless of initial bio-ADM levels, and its change over 90
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Introduction: Prognostication of outcome in severe stroke patients necessitating invasive mechanical ventilation poses significant challenges. The objective of this study was to assess the prognostic significance and prevalence of early electroencephalogram (EEG) abnormalities in adult stroke patients receiving mechanical ventilation.

Methods: This study is a pre-planned ancillary investigation within the prospective multicenter SPICE cohort study (2017-2019), conducted in 33 intensive care units (ICUs) in the Paris area, France.

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Background: The STRONG-HF trial showed that high-intensity care (HIC) consisting of rapid up-titration of guideline-directed medical therapy (GDMT) and close follow-up reduced all-cause death or heart failure (HF) readmission at 180 days compared to usual care (UC). We hypothesized that significant differences in patient characteristics, management, and outcomes over the enrolment period may exist.

Methods: Two groups of the 1,078 patients enrolled in STRONG-HF were created according to the order of enrolment within center.

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  • The study investigates the safety, tolerability, and efficacy of high-intensity care (HIC) for heart failure using the MAGGIC risk score, which is a risk assessment tool for patients with chronic heart failure.
  • Patients in the STRONG-HF trial were divided into two groups, one receiving HIC with rapid medication uptitration and the other receiving usual care, with the main goal of comparing outcomes such as death and hospitalization rates at 180 days.
  • Results showed that while HIC led to higher medication use, the overall death or readmission rates varied according to the MAGGIC risk score, suggesting that the severity of heart failure risk impacts treatment outcomes.
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Background: This analysis provides details on baseline and changes in quality of life (QoL) and its components as measured by EQ-5D-5L questionnaire, as well as association with objective outcomes, applying high-intensity heart failure (HF) care in patients with acute HF.

Methods: In STRONG-HF trial (Safety, Tolerability, and Efficacy of Rapid Optimization, Helped by NT-proBNP Testing, of Heart Failure Therapies) patients with acute HF were randomized just before discharge to either usual care or a high-intensity care strategy of guideline-directed medical therapy up-titration. Patients ranked their state of health on the EQ-5D visual analog scale score ranging from 0 (the worst imaginable health) to 100 (the best imaginable health) at baseline and at 90 days follow-up.

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  • - The study investigates the effectiveness of a high-intensity care (HIC) strategy with rapid guideline-directed medical therapy (GDMT) compared to usual care (UC) for patients hospitalized due to acute heart failure (AHF) and examines the influence of baseline systolic blood pressure (SBP).
  • - Researchers analyzed the outcomes of 1,075 patients categorized by their baseline SBP and changes in SBP after discharge, finding that the benefits of HIC were not influenced by baseline SBP levels or early changes in SBP.
  • - Results showed that patients in the HIC group achieved similar target doses of GDMT regardless of whether they had increased, stable, or decreased SBP within the first week after discharge,
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Purpose: The present study aimed at assessing the prevalences of post-traumatic stress disorder (PTSD) (main objective), anxiety, depression, and burnout syndrome (BOS) and their associated factors in intensive care unit (ICU) staff workers in the second year of the COVID-19 pandemic.

Materials And Methods: An international cross-sectional multicenter ICU-based online survey was carried out among the ICU staff workers in 20 ICUs across 3 continents. ICUs staff workers (both caregivers and non-caregivers) were invited to complete PCL-5, HADS, and MBI questionnaires for assessing PTSD, anxiety, depression, and the different components of BOS, respectively.

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Importance: The Safety, Tolerability, and Efficacy of Rapid Optimization, Helped by N-Terminal Pro-Brain Natriuretic Peptide Testing of Heart Failure Therapies (STRONG-HF) trial strived for rapid uptitration aiming to reach 100% optimal doses of guideline-directed medical therapy (GDMT) within 2 weeks after discharge from an acute heart failure (AHF) admission.

Objective: To assess the association between degree of GDMT doses achieved in high-intensity care and outcomes.

Design, Setting, And Participants: This was a post hoc secondary analysis of the STRONG-HF randomized clinical trial, conducted from May 2018 to September 2022.

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Objective: Post-partum hemorrhage (PPH) is the leading preventable cause of worldwide maternal morbidity and mortality. Risk factors for psychological disorders following PPH are currently unknown. HELP-MOM study aimed to determine the incidence and identify risk factors for psychological disorders following PPH.

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  • This study investigates the long-term health outcomes of survivors of cardiogenic shock (CS) using clinical data collected from ICU patients to identify distinct survivor phenotypes and their associated risks.
  • Two main phenotypes of CS survivors were discovered: Phenotype A, which showed better overall health outcomes, and Phenotype B, which had worse health markers and a significantly higher risk of mortality within one year of ICU discharge.
  • Patients in Phenotype B exhibited more severe symptoms and disabilities, including higher levels of anemia and inflammation, leading to poorer quality of life and increased mortality risk compared to those in Phenotype A.
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Vascular endothelial dysfunction is a major risk factor in the development of renal diseases. Recent studies pointed out a major interest for the inter-endothelial junction protein CD146, as its expression is modulated during renal injury. Indeed, some complex mechanisms involving this adhesion molecule and its multiple ligands are observed in a large number of renal diseases in fundamental or clinical research.

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Background: Intraoperative arterial hypotension (IOH) leads to increased postoperative morbidity. Norepinephrine is often use to treat IOH. The question regarding the mode of administration in either a bolus or continuous infusion remains unanswered.

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Aim: In this subgroup analysis of STRONG-HF, we explored the association between changes in renal function and efficacy of rapid up-titration of guideline-directed medical therapy (GDMT) according to a high-intensity care (HIC) strategy.

Methods And Results: In patients randomized to the HIC arm (n = 542), renal function was assessed at baseline and during follow-up visits. We studied the association with clinical characteristics and outcomes of a decrease in estimated glomerular filtration rate (eGFR) at week 1, defined as ≥15% decrease from baseline.

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Background: Safety, Tolerability and Efficacy of Rapid Optimization, Helped by NT-proBNP Testing, of Heart Failure Therapies (STRONG-HF) demonstrated the safety and efficacy of rapid up-titration of guideline-directed medical therapy (GDMT) with high-intensity care (HIC) compared with usual care in patients hospitalized for acute heart failure (HF). In the HIC group, the following safety indicators were used to guide up-titration: estimated glomerular filtration rate of <30 mL/min/1.73 m, serum potassium of >5.

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Background: Acute kidney injury (AKI) is a common condition in severely ill patients associated with poor outcomes. We assessed the associations between urinary neutrophil gelatinase-associated lipocalin (uNGAL), urinary liver-type fatty acid-binding protein (uLFABP), and urinary cystatin C (uCysC) concentrations and patient outcomes.

Methods: We assessed the predictive performances of uNGAL, uLFABP, and uCysC measured in the early phase of intensive care unit (ICU) management and at discharge from the ICU in severely ill patients for short- and long-term outcomes.

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  • Acute kidney injury (AKI) is a serious problem for patients in intensive care units, and a new stage called subclinical AKI (sAKI) has been identified, where there are signs of kidney issues but no rise in certain blood markers.
  • Researchers studied the urine of 1,885 patients to find unique patterns (called urinary peptide signatures) linked to sAKI, which are similar to patterns seen in AKI.
  • The findings suggest that sAKI is quite common and can also lead to serious outcomes, like increased risk of death, just like AKI.
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