Publications by authors named "Jean Paul Mira"
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
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.
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- A retrospective study conducted in a medical ICU from 2016 to 2020 examined cases of bloodstream infections (BSI) caused by Klebsiella pneumoniae, focusing on a hypervirulent strain (hvKP).
- Out of 70 patients with K. pneumoniae BSI, 9 (13%) were identified with hvKP, with a significant number (56%) having pneumonia as the cause of the infection.
- The study highlighted that a considerable portion of hvKP-BSI patients were homeless (56%), and while the 30-day mortality rate was high (44%), it did not significantly differ from that of classical Klebsiella pneumoniae BSI (cKP).
Purpose: Patients with COVID-19 admitted to intensive care unit (ICU) may have right ventricular (RV) injury. The main goal of this study was to investigate the incidence of RV injury and to describe the patient trajectories in terms of RV injury during ICU stay.
Methods: Prospective and bicentric study with standardized transthoracic echocardiographic (TTE) follow-up during ICU stay with a maximum follow-up of 28 days.
Background: Although it has been reported that patients with pneumococcal pneumonia may develop meningitis, lumbar puncture is not systematically recommended in these patients, even in patients with associated bacteremia or invasive pneumococcal disease. The aim of this study was to determine the characteristics and outcomes of patients admitted to intensive care unit (ICU) for pneumococcal community-acquired pneumonia who developed meningitis.
Methods: We retrospectively included all consecutive patients admitted to our ICU from January 2006 to December 2020 for severe pneumococcal community-acquired pneumonia according to American Thoracic Society criteria.
Article Synopsis
- COVID-19 infections can lead to serious inflammation and potential cardiac injury, with factors like biological sex possibly influencing outcomes for patients in the ICU.
- A study of 198 ICU patients revealed that 60% experienced cardiac injury, showing no significant differences between men and women in this regard.
- Patients with cardiac injury had more cardiovascular risk factors and higher mortality rates, along with notable differences in inflammation and lymphocyte levels upon admission.
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.
Article Synopsis
- Recent research suggests that activating the renin-angiotensin system may contribute to cancer growth, leading to the consideration of renin-angiotensin system blockers (RABs) as potential treatments for improving survival in cancer patients.
- A study conducted in a medical ICU included 1,845 solid cancer patients, examining the effects of RABs, particularly angiotensin-receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEis), on in-ICU and one-year survival rates.
- Findings indicated that both ARBs and ACEis were linked to better in-ICU survival, with ARBs also significantly reducing one-year mortality, highlighting the potential benefits of RABs in managing critically ill cancer
Article Synopsis
- Imported malaria is becoming a significant health issue in non-endemic countries, particularly due to increased global travel, prompting a study to explore cytokine profiles in affected individuals in France.
- The research involved 278 adults with Plasmodium falciparum malaria, classifying them into uncomplicated (UM) and severe malaria (SM), with findings showing a notable association between high IL-10 levels and both disease severity and higher parasitemia.
- The study revealed that many patients had undetectable cytokine levels at admission, indicating that routine cytokine testing may not be useful, but high IL-10 concentrations could be important for monitoring severe cases and potential infections.
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.
Background: Activation of the triggering receptor expressed on myeloid cells-1 (TREM-1) pathway is associated with septic shock outcomes. Data suggest that modulation of this pathway in patients with activated TREM-1 might improve survival. Soluble TREM-1 (sTREM-1), a potential mechanism-based biomarker, might facilitate enrichment of patient selection in clinical trials of nangibotide, a TREM-1 modulator.
View Article and Find Full Text PDFPurpose: Whether thrombocytopenia in critically ill patients accounts for a bystander of severity or drives specific complications is unclear. We addressed the effect of thrombocytopenia on septic shock, with emphasis on intensive care unit (ICU)-acquired bleeding, infections and thrombotic complications.
Materials And Methods: A retrospective (2008-2019) single-center study of patients with septic shock.
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.
Article Synopsis
- A phase 3 clinical trial investigated if intravenous hydrocortisone could reduce mortality in patients with severe community-acquired pneumonia compared to a placebo.
- The study involved 800 patients, and results showed that those receiving hydrocortisone had a significantly lower death rate (6.2%) at 28 days versus 11.9% in the placebo group.
- Additionally, patients on hydrocortisone required less mechanical ventilation and vasopressors compared to those on placebo, with similar rates of hospital-acquired infections and bleeding risks.
Objective: To describe clinical and early shoulder-girdle MR imaging findings in severe COVID-19-related intensive care unit-acquired weakness (ICU-AW) after ICU discharge.
Methods: A single-center prospective cohort study of all consecutive patients with COVID-19-related ICU-AW from November 2020 to June 2021. All patients underwent similar clinical evaluations and shoulder-girdle MRI within the first month and then 3 months (± 1 month) after ICU discharge.
Article Synopsis
- The study aimed to evaluate the effects of intravenous CYT107, a recombinant human IL-7, in sepsis patients, focusing on its ability to reverse lymphopenia and improve immune function.
- Twenty-one patients were enrolled, but the trial was halted early due to adverse reactions in some who received IV CYT107, despite observing increased lymphocyte counts similar to intramuscular administration.
- Ultimately, while IV CYT107 showed effectiveness, it caused transient respiratory distress and is deemed less preferable than intramuscular administration due to better tolerability and pharmacokinetics.
Article Synopsis
- The RECORDS trial investigates how different adult patients with sepsis respond to corticosteroids by categorizing them into distinct groups based on their likelihood of responding to treatment.
- It is a large, placebo-controlled study that includes 1800 adults with conditions like pneumonia and septic shock, randomly assigning them to receive either corticosteroids or placebo for 7 to 10 days.
- The primary goal is to assess the impact of corticosteroids on mortality and organ dysfunction after 90 days, with the findings expected to be shared at conferences and published in scientific journals.
Clinical observations suggest that the source of primary infection accounts for a major determinant of further nosocomial pneumonia in critically ill patients with sepsis. Here we addressed the impact of primary nonpulmonary or pulmonary septic insults on lung immunity using relevant double-hit animal models. C57BL/6J mice were first subjected to polymicrobial peritonitis induced by cecal ligation and puncture (CLP) or bacterial pneumonia induced by intratracheal challenge with .
View Article and Find Full Text PDFBackground: The anatomic site for central venous catheter insertion influences the risk of central venous catheter-related intravascular complications. We developed and validated a predictive score of required catheter dwell time to identify critically ill patients at higher risk of intravascular complications.
Methods: We retrospectively conducted a cohort study from three multicenter randomized controlled trials enrolling consecutive patients requiring central venous catheterization.
Background: Necrotizing skin and soft tissue infections (NSTIs) are rare but serious and rapidly progressive infections characterized by necrosis of subcutaneous tissue, fascia and even muscle. The care pathway of patients with NSTIs is poorly understood. A better characterization of the care trajectory of these patients and a better identification of patients at risk of a complicated evolution, requiring prolonged hospitalization, multiple surgical re-interventions, or readmission to the intensive care unit (ICU), is an essential prerequisite to improve their care.
View Article and Find Full Text PDFBackground: High-flow nasal oxygen therapy (HFNC) may be an attractive first-line ventilatory support in COVID-19 patients. However, HNFC use for the management of COVID-19 patients and risk factors for HFNC failure remain to be determined.
Methods: In this retrospective study, we included all consecutive COVID-19 patients admitted to our intensive care unit (ICU) in the first (Mars-May 2020) and second (August 2020- February 202) French pandemic waves.
Background: Strong evidence suggests a correlation between pharmacodynamics (PD) index and antibiotic efficacy while dose adjustment should be considered in critically ill patients due to modified pharmacokinetic (PK) parameters and/or higher minimum inhibitory concentrations (MICs). This study aimed to assess pharmacodynamic (PD) target attainment considering both antibiotics serum concentrations and measured MICs in these patients. Method: A multicentric prospective open-label trial conducted in 11 French ICUs involved patients with Gram-negative bacilli (GNB) ventilator-associated pneumonia (VAP) confirmed by quantitative cultures.
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.
Background: In patients with septic shock, the impact of the mean arterial pressure (MAP) target on the course of mottling remains uncertain. In this post hoc analysis of the SEPSISPAM trial, we investigated whether a low-MAP (65 to 70 mmHg) or a high-MAP target (80 to 85 mmHg) would affect the course of mottling and arterial lactate in patients with septic shock.
Methods: The presence of mottling was assessed every 2 h from 2 h after inclusion to catecholamine weaning.