Publications by authors named "Guillaume Lacave"
Article Synopsis
- The study focused on cytomegalovirus end-organ disease (CMV-EOD) in critically ill, immunocompromised patients across 18 ICUs in France, Israel, and Spain, analyzing clinical characteristics and patient outcomes from January 2010 to December 2021.
- A total of 185 patients were examined, with pneumonia being the most common form of CMV-EOD, affecting 62.2%, followed by gastrointestinal disease; the overall hospital mortality rate was strikingly high at 61.4%.
- Key factors linked to increased mortality included having hematologic malignancies, particularly with active graft-versus-host disease, experiencing CMV pneumonia, and low lymphocyte counts
Purpose: The effect of renal replacement therapy (RRT) in comatose patients with acute kidney injury (AKI) remains unclear. We compared two RRT initiation strategies on the probability of awakening in comatose patients with severe AKI.
Methods: We conducted a post hoc analysis of a trial comparing two delayed RRT initiation strategies in patients with severe AKI.
Article Synopsis
- The study investigates fluid intake in ICU patients at risk of negative outcomes due to excessive fluid balance, highlighting the need for fluid optimization beyond traditional resuscitation.
- Conducted across multiple ICUs in France and Spain, it recorded the types and volumes of fluids administered to patients needing vasopressors or invasive ventilation over a 24-hour period.
- Results indicate that only 36% of the total fluid volume was essential for body fluid homeostasis, with significant variations in fluid administration based on the specific ICU, suggesting a strong center effect on fluid management practices.
Background: This study was carried out to compare characteristics and outcomes in patients with acute respiratory failure related to COVID-19 during first, second, and third waves.
Methods: We included consecutive adults admitted to the intensive care unit between March 2020 and July 2021. We compared three groups defined by the epidemic intake phase: waves 1 (W1), 2 (W2), and 3 (W3).
Individualize treatment after cardiac arrest could potentiate future clinical trials selecting patients most likely to benefit from interventions. We assessed the Cardiac Arrest Hospital Prognosis (CAHP) score for predicting reason for death to improve patient selection. Consecutive patients in two cardiac arrest databases were studied between 2007 and 2017.
View Article and Find Full Text PDFBackground: Spontaneous-breathing trials can be performed with the use of either pressure-support ventilation (PSV) or a T-piece. Whether PSV trials may result in a shorter time to tracheal extubation than T-piece trials, without resulting in a higher risk of reintubation, among patients who have a high risk of extubation failure is unknown.
Methods: In this multicenter, open-label trial, we randomly assigned patients who had a high risk of extubation failure (i.
Article Synopsis
- - The study examined the impact of ventilator type on hospital mortality for patients with ARDS due to COVID-19 in a French ICU from March 2020 to July 2021.
- - Out of 189 patients, factors such as age over 70, immunodeficiency, and high serum creatinine levels were linked to higher mortality, while the type of ventilator used did not influence survival rates.
- - Both ICU settings (standard vs. transient ICU with simpler ventilators) showed similar lengths of mechanical ventilation and ICU stays, indicating that less complex ventilators did not lead to worse patient outcomes.
Although noninvasive ventilation (NIV) may prevent reintubation in patients at high risk of extubation failure in ICUs, this oxygenation strategy has not been specifically assessed in obese patients. We hypothesized that NIV may decrease the risk of reintubation in obese patients compared with high-flow nasal oxygen. analysis of a multicenter randomized controlled trial (not prespecified) comparing NIV alternating with high-flow nasal oxygen versus high-flow nasal oxygen alone after extubation, with the aim of assessing NIV effects according to patient body mass index (BMI).
View Article and Find Full Text PDFBackground: In intensive care units (ICUs), patients experiencing post-extubation respiratory failure have poor outcomes. The use of noninvasive ventilation (NIV) to treat post-extubation respiratory failure may increase the risk of death. This study aims at comparing mortality between patients treated with NIV alternating with high-flow nasal oxygen or high-flow nasal oxygen alone.
View Article and Find Full Text PDFArticle Synopsis
- The study explored whether delaying renal replacement therapy (RRT) initiation in critically ill patients with severe acute kidney injury could lead to more days without the need for RRT.
- Conducted in 39 intensive care units in France, the trial randomized 278 patients into two groups: an immediate RRT group and a more-delayed group that only started RRT based on specific clinical indicators.
- Results showed similar complications and a median of 12 RRT-free days for the delayed group compared to 10 days for the more-delayed group, leading to a conclusion that delaying RRT does not significantly enhance patient outcomes.
Background: Several randomized clinical trials have shown that non-invasive ventilation (NIV) applied immediately after extubation may prevent reintubation in patients at high-risk of extubation failure. However, most of studies included patients with chronic respiratory disorders as well as patients without underlying respiratory disease. To date, no study has shown decreased risk of reintubation with prophylactic NIV after extubation among patients with chronic obstructive pulmonary disease (COPD).
View Article and Find Full Text PDFArticle Synopsis
- * Conducted across 69 adult ICUs in 14 countries, the study analyzed data from 2088 patients aged 18 and older who were admitted with severe COVID-19 before April 28, 2020, excluding those with certain pre-existing conditions.
- * The findings revealed that out of 4530 admitted patients, 66.9% required invasive mechanical ventilation, highlighting the significant risk of acute brain dysfunction among severely ill COVID-19 patients.
Introduction: In intensive care unit (ICU), the decision of extubation is a critical time because mortality is particularly high in case of reintubation. To reduce that risk, guidelines recommend to systematically perform a spontaneous breathing trial (SBT) before extubation in order to mimic the postextubation physiological conditions. SBT is usually performed with a T-piece disconnecting the patient from the ventilator or with low levels of pressure-support ventilation (PSV).
View Article and Find Full Text PDFBackground: Spontaneous breathing trial (SBT) using a T-piece remains the most frequently performed trial before extubation in ICUs.
Research Question: We aimed at determining whether initial SBT using pressure-support ventilation (PSV) could increase successful extubation rates among patients at high risk of extubation failure.
Study Design And Methods: Post hoc analysis of a multicenter trial focusing on reintubation in patients at high-risk of extubation failure.
Background: The Artificial Kidney Initiation in Kidney Injury (AKIKI) trial showed that a delayed renal replacement therapy (RRT) strategy for severe acute kidney injury (AKI) in critically ill patients was safe and associated with major reduction in RRT initiation compared with an early strategy. The five criteria which mandated RRT initiation in the delayed arm were: severe hyperkalemia, severe acidosis, acute pulmonary edema due to fluid overload resulting in severe hypoxemia, serum urea concentration > 40 mmol/l and oliguria/anuria > 72 h. However, duration of anuria/oliguria and level of blood urea are still criteria open to debate.
View Article and Find Full Text PDFImportance: High-flow nasal oxygen may prevent postextubation respiratory failure in the intensive care unit (ICU). The combination of high-flow nasal oxygen with noninvasive ventilation (NIV) may be an optimal strategy of ventilation to avoid reintubation.
Objective: To determine whether high-flow nasal oxygen with prophylactic NIV applied immediately after extubation could reduce the rate of reintubation, compared with high-flow nasal oxygen alone, in patients at high risk of extubation failure in the ICU.
Article Synopsis
- Recent guidelines recommend using non-invasive ventilation (NIV) to prevent respiratory failure in ICU patients after extubation, but the evidence is not very strong; high-flow nasal cannula (HFNC) is considered effective as well.
- The study will compare the effectiveness of HFNC alone versus HFNC combined with NIV in reducing reintubation rates among high-risk patients in the ICU.
- The trial will include 600 participants, measuring outcomes like reintubation rates and ICU stay length, with ethics approval and plans for future publication.
Objective: To determine whether prior antimicrobial therapy, divided in recent or current antibiotic treatment, influences the identification rate and/or the type of causative pathogens in patients with suspected episodes of ventilator-acquired pneumonia.
Design: Monocentric retrospective study.
Setting: Intensive car unit in a universitary hospital.
Objectives: RBC transfusion is often required in patients with sepsis. However, adverse events have been associated with RBC transfusion, raising safety concerns. A randomized controlled trial validated the 7 g/dL threshold, but previously transfused patients were excluded.
View Article and Find Full Text PDFPurpose: Identifying modifiable factors for sepsis-associated encephalopathy may help improve patient care and outcomes.
Methods: We conducted a retrospective analysis of a prospective multicenter database. Sepsis-associated encephalopathy (SAE) was defined by a score on the Glasgow coma scale (GCS) <15 or when features of delirium were noted.
Article Synopsis
- * A study of 107 critically ill patients receiving continuous intravenous vancomycin found that 29% developed acute kidney injury (AKI) during treatment targeting serum levels of 20 to 30 mg/L.
- * Key risk factors for AKI included serum vancomycin levels of 40 mg/L or higher, a higher number of organ failures, and liver cirrhosis.
We report a human case of infective endocarditis caused by Streptococcus canis. Identification was carried out from positive blood culture using mass spectrometry and SodA gene sequencing. S.
View Article and Find Full Text PDFObjectives: Pancreaticoduodenectomy (PD) is associated with high morbidity, in part as a result of infectious complications increased by preoperative bile contamination. The aim of the present study was to assess the effect on the incidence of infectious complications of short-term antimicrobial therapy (AMT) in high-risk patients.
Methods: Patients with a high risk for positive intraoperative bile culture (i.