Publications by authors named "FranCois Lamontagne"
Purpose: We hypothesised that the biological heterogeneity of sepsis may highlight sepsis subtypes with differences in response to intravenous vitamin C treatment in the Lessening Organ Dysfunction with VITamin C (LOVIT) trial. Our aims were to identify sepsis subtypes and to test whether sepsis subtypes have differences in treatment effect to vitamin C and describe putative biological effects of vitamin C treatment.
Methods: We measured biomarkers of inflammation, at baseline and at 7 days post-randomisation, in 457/863 (53.
Article Synopsis
- The study investigates differences in thrombo-inflammatory responses and outcomes between non-COVID-19 community-acquired pneumonia (CAP) and COVID-19 CAP in hospitalized adults in Canada.
- Non-COVID-19 CAP patients displayed lower 28-day mortality rates and fewer complications compared to those with COVID-19, indicating a more effective immune response developed over time against bacterial infections.
- The findings suggest that the complexities of the immune response to COVID-19 resulted in higher mortality rates, highlighting the challenges posed by emerging viruses compared to known pathogens.
Background: Most Canadians receive their care in community hospitals, yet most clinical research is conducted in academic hospitals. This study aims to compare patients with community acquired pneumonia (CAP) treated in academic and community hospitals with respect to their demographics, clinical characteristics, treatments and outcomes.
Methods: This nested observational cohort substudy of the Community Acquired Pneumonia: Toward InnoVAtive Treatment (CAPTIVATE) trial included 1,329 hospitalized adults with CAP recruited between March 1st, 2018 and September 31st, 2023 from 15 Canadian hospitals.
Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections.
N Engl J Med
November 2024
Background: Bloodstream infections are associated with substantial morbidity and mortality. Early, appropriate antibiotic therapy is important, but the duration of treatment is uncertain.
Methods: In a multicenter, noninferiority trial, we randomly assigned hospitalized patients (including patients in the intensive care unit [ICU]) who had bloodstream infection to receive antibiotic treatment for 7 days or 14 days.
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.
Early administration of appropriate antibiotics has been shown to be among the most effective interventions to reduce mortality in septic patients. We evaluated the attainment of efficacy and safety targets at 24 h associated with the use of intensive beta-lactam therapy in patients admitted to the intensive care unit for sepsis. This was a prospective study with patients who received beta-lactams for sepsis or septic shock between February 2023 and September 2023.
View Article and Find Full Text PDFEarly In-Bed Cycle Ergometry With Critically Ill, Mechanically Ventilated Patients: Statistical Analysis Plan for CYCLE (Critical Care Cycling to Improve Lower Extremity Strength), an International, Multicenter, Randomized Clinical Trial.
JMIR Res Protoc
October 2024
Article Synopsis
- Survivors of critical illness often experience physical dysfunction post-ICU discharge, and the CYCLE trial aims to evaluate the effectiveness of in-bed cycle ergometry for improving short-term physical function in these patients.!* -
- The CYCLE trial, involving 360 patients across multiple centers, employs a prespecified statistical analysis plan to assess outcomes like the PFIT-s score three days after ICU discharge, while considering variables such as age, frailty, and sex.!* -
- Funded in 2017, the CYCLE study completed enrollment in May 2023, with data analyses finished and first results expected to be published in 2024.!*
Article Synopsis
- The study investigates how often to screen critically ill adults on ventilators and the best method for conducting spontaneous breathing trials (SBT) to successfully extubate them.
- It involves a randomized clinical trial with 797 participants who required mechanical ventilation, comparing once-daily and more frequent screenings alongside two SBT techniques: pressure-supported and T-piece.
- Results show no significant differences in the time to successful extubation based on screening frequency or SBT technique, indicating that both methods may be similarly effective.
Article Synopsis
- 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
- The COVID-19 pandemic significantly disrupted clinical trials globally, leading to issues such as premature closures and compromised trial integrity, necessitating changes in research protocols.
- The study aimed to assess challenges faced during interrupted critical care trials, identifying barriers and developing strategies for future trials based on input from principal investigators and project coordinators.
- Results indicated that major challenges included the prioritization of COVID-19 studies and restrictions on hospital visitation, while participants offered various solutions and suggestions to enhance trial conduct moving forward.
Objectives: Although clinicians may use methylene blue (MB) in refractory septic shock, the effect of MB on patient-important outcomes remains uncertain. We conducted a systematic review and meta-analysis to investigate the benefits and harms of MB administration in patients with septic shock.
Data Sources: We searched six databases (including PubMed, Embase, and Medline) from inception to January 10, 2024.
Background: The response of Canada's research community to the COVID-19 pandemic provides a unique opportunity to examine the country's clinical health research ecosystem. We sought to describe patterns of enrolment across Canadian Institutes of Health Research (CIHR)-funded studies on COVID-19.
Methods: We identified COVID-19 studies funded by the CIHR and that enrolled participants from Canadian acute care hospitals between January 2020 and April 2023.
Article Synopsis
- A study was conducted to evaluate the effects of the proton-pump inhibitor pantoprazole on critically ill patients undergoing invasive ventilation, comparing it to a placebo.
- The trial included 4,821 patients and found that pantoprazole significantly reduced the incidence of clinically important upper gastrointestinal bleeding compared to placebo (1.0% vs. 3.5%).
- However, there was no significant difference in overall mortality rates at 90 days between the pantoprazole group (29.1%) and the placebo group (30.9%).
Article Synopsis
- * A pilot randomized trial will involve 90 donors and 324 organ recipients across nine hospitals in Ontario and Québec, with participants receiving either tacrolimus or a placebo before organ retrieval.
- * Researchers will assess the trial's feasibility, including donor enrollment and recipient consent, while monitoring graft function and survival; findings will be shared publicly through publications and conferences.
Background: The effect of a liberal transfusion strategy as compared with a restrictive strategy on outcomes in critically ill patients with traumatic brain injury is unclear.
Methods: We randomly assigned adults with moderate or severe traumatic brain injury and anemia to receive transfusion of red cells according to a liberal strategy (transfusions initiated at a hemoglobin level of ≤10 g per deciliter) or a restrictive strategy (transfusions initiated at ≤7 g per deciliter). The primary outcome was an unfavorable outcome as assessed by the score on the Glasgow Outcome Scale-Extended at 6 months, which we categorized with the use of a sliding dichotomy that was based on the prognosis of each patient at baseline.
Article Synopsis
- Critical illness requiring invasive mechanical ventilation can lead to significant physical disability, and early in-bed cycle ergometry may help reduce this impairment when added to standard physiotherapy in ICU patients.
- A study with 360 adult patients randomly assigned to either early in-bed cycling plus usual physiotherapy or just usual physiotherapy found no significant difference in physical function scores three days after ICU discharge.
- The addition of cycling did not result in any serious adverse events, indicating it is safe, but did not enhance recovery outcomes compared to standard therapy alone.
Background And Objective: Collection of biosamples for translational research studies is vital for understanding biological pathways, discovering disease-related biomarkers, and identifying novel therapeutic targets. However, a lack of infrastructure for sample procurement, processing, storage, and shipping may hinder the ability of clinical research units to effectively engage in translational research. The purpose of this study was to identify the barriers to biosampling-based translational research in the critical care setting in Canada.
View Article and Find Full Text PDFArticle Synopsis
- ARDS (Acute Respiratory Distress Syndrome) is a critical condition linked mainly to infections like COVID-19, influenza, and bacterial pneumonia, and research is focused on its mechanisms and treatment options.
- The study aims to compare metabolic profiles of ARDS caused by COVID-19, H1N1 influenza, and bacterial pneumonia to understand their unique metabolic pathways.
- Results showed distinct metabolic differences based on the infection type, indicating different underlying mechanisms in ARDS associated with each infectious cause.
BACKGROUND: Trials and study-level meta-analyses have failed to resolve the role of corticosteroids in the management of patients with septic shock. Patient-level meta-analyses may provide more precise estimates of treatment effects, particularly subgroup effects. METHODS: We pooled individual patient data from septic shock trials investigating the adjunctive use of intravenous hydrocortisone.
View Article and Find Full Text PDFRandomized controlled trials (RCTs) have traditionally been considered the gold standard for medical evidence. However, in light of emerging methodologies in data science, many experts question the role of RCTs. Within this context, experts in the USA and Canada came together to debate whether the primacy of RCTs as the gold standard for medical evidence, still holds in light of recent methodological advances in data science and in the era of big data.
View Article and Find Full Text PDFImportance: Research diversity and representativeness are paramount in building trust, generating valid biomedical knowledge, and possibly in implementing clinical guidelines.
Objectives: To compare variations over time and across World Health Organization (WHO) geographic regions of corticosteroid use for treatment of severe COVID-19; secondary objectives were to evaluate the association between the timing of publication of the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial (June 2020) and the WHO guidelines for corticosteroids (September 2020) and the temporal trends observed in corticosteroid use by region and to describe the geographic distribution of the recruitment in clinical trials that informed the WHO recommendation.
Design, Setting, And Participants: This prospective cohort study of 434 851 patients was conducted between January 31, 2020, and September 2, 2022, in 63 countries worldwide.