Publications by authors named "Klouche K"
Article Synopsis
- Cardiovascular diseases are the leading cause of illness and death in chronic kidney disease patients, with a study analyzing the impact of coronary artery calcifications (CAC) and cardiovascular biomarkers on major adverse cardiovascular events and deaths.
- The study involved 425 non-dialysis CKD patients who underwent scans for CAC scoring and measurement of various cardiovascular risk biomarkers, with follow-up lasting an average of about 3.6 years.
- Findings indicate that high CAC levels significantly increase the risk of major adverse cardiovascular events, especially when combined with certain inflammatory and metabolic conditions, suggesting that managing inflammation and improving mineral metabolism could be key strategies for reducing cardiovascular risk in these patients.
Article Synopsis
- The study aimed to analyze the characteristics and outcomes of critically ill patients with severe pneumonia caused by SARS-CoV-2 across different pandemic waves, focusing on morbidity and mortality predictors.
- Conducted from March 2020 to October 2021, the study included 437 adult patients and found that ICU mortality decreased from 26% in the first wave to around 10% in later waves, with factors like age and comorbidities influencing death risk.
- The research concluded that overall survival improved due to the effects of interventions like vaccination and dexamethasone, although bronchopulmonary aspergillosis increased mortality risk significantly to 36%.
Purpose: Net ultrafiltration (UF) during continuous renal replacement therapy (CRRT) can control fluid balance (FB), but is usually 0 ml·h in patients with vasopressors due to the risk of hemodynamic instability associated with CRRT (HIRRT). We evaluated a UF strategy adjusted by functional hemodynamics to control the FB of patients with vasopressors, compared to the standard of care.
Methods: In this randomized, controlled, open-label, parallel-group, multicenter, proof-of-concept trial, adults receiving vasopressors, CRRT since ≤ 24 h and cardiac output monitoring were randomized (ratio 1:1) to receive during 72 h a UF ≥ 100 ml·h, adjusted using a functional hemodynamic protocol (intervention), or a UF ≤ 25 ml·h (control).
Article Synopsis
- The study aimed to evaluate the effectiveness of the 2021 ERC/ESICM algorithm in predicting neurological outcomes for cardiac arrest survivors in intensive care.
- A total of 337 patients were examined, with the algorithm successfully identifying all 175 patients predicted to have poor neurological outcomes and showing high specificity for various predictive tools like EEG and clinical examination.
- For patients with uncertain outcomes, favorable indicators could help predict positive recovery, providing valuable guidance in prognosis and treatment decisions.
Background: The severity and course of sepsis-associated acute kidney injury (SA-AKI) are correlated with the mortality rate. Early detection of SA-AKI subphenotypes might facilitate the rapid provision of individualized care.
Patients And Methods: In this analysis of a multicenter prospective study, we combined conventional kidney function variables with serial measurements of urine (tissue inhibitor of metalloproteinase-2 [TIMP-2])* (insulin-like growth factor-binding protein [IGFBP7]) at 0, 6, 12, and 24 h) and then using an unsupervised hierarchical clustering of principal components (HCPC) approach to identify different phenotypes of SA-AKI.
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.
Objectives: The aim of this study was to determine, in critically ill patients treated with therapeutic plasma exchange (TPE), the incidence of adverse events as well as the incidence of secondary infections and its predictive factors.
Design: A multicenter retrospective cohort study of an intensive care population treated with TPE to collect adverse events and infectious complications. The characteristics of patients who developed an infection after plasma exchange were compared with those of patients who did not.
Around 10% of critically ill patients suffer acute kidney injury (AKI) requiring kidney replacement therapy (KRT), with a mortality rate approaching 50%. Although most survivors achieve sufficient renal recovery to be weaned from KRT, there are no recognized guidelines on the optimal period for weaning from KRT. A systematic review was conducted using a peer-reviewed strategy, combining themes of KRT (intermittent hemodialysis, CKRT: continuous veno-venous hemo/dialysis/filtration/diafiltration, sustained low-efficiency dialysis/filtration), factors predictive of successful weaning (defined as a prolonged period without new KRT) and patient outcomes.
View Article and Find Full Text PDFPsychological resilience (the ability to thrive in adversity) may protect against mental-health symptoms in healthcare professionals during coronavirus disease (COVID-19) waves. To identify determinants of resilience in ICU staff members. In this cross-sectional survey in 21 French ICUs, staff members completed the 10-item Connor-Davidson Resilience Scale, Hospital Anxiety and Depression Scale, and Impact of Event Scale-Revised (for post-traumatic stress disorder [PTSD]).
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- Tubular injury is identified as the primary cause of acute kidney injury (AKI) in critically ill patients with COVID-19, with proximal tubular dysfunction (PTD) and specific urinary biomarkers potentially indicating AKI before it occurs.
- A study analyzing 60 ICU COVID-19 patients revealed that 48% had PTD, 55% developed AKI, and 33% experienced persistent AKI, with urinary NGAL being the most effective biomarker for predicting these conditions.
- The findings highlight that while PTD and AKI were common among patients, higher levels of the simplified acute physiology score (SAPSII) and certain medical treatments contributed significantly to the risk of AKI.
Purpose: Studies have suggested benefits from magnesium sulphate in thrombotic thrombocytopenic purpura (TTP). We aimed to measure the effects of magnesium sulphate supplementation on TTP recovery.
Methods: In this multicenter, randomised, double-blind, controlled, superiority study, we enrolled adults with a clinical diagnosis of TTP.
Article Synopsis
- Acute respiratory failure (ARF) is common in ICU admissions, particularly among immunocompromised patients, yet there is limited understanding of the role of viruses in this context.
- In a study of 4038 immunocompromised patients, 9.2% had virus-detected ARF, with influenza being the most prevalent virus; significant mortality and factors influencing it were identified, including neutropenia and invasive mechanical ventilation needs.
- Remarkably, patients with virus-detected ARF had lower mortality rates compared to those with ARF from other causes, suggesting that certain viruses may have a less severe impact overall.
Article Synopsis
- Out-of-hospital cardiac arrest (OHCA) varies in cause and prognosis, prompting a study to assess the effectiveness of the Cardiac Arrest Prognosis (CAHP) Score compared to traditional methods (Utstein style criteria) for predicting patient outcomes.
- The study collected data from 24 ICUs in France and Belgium on comatose patients with OHCA who had a stable return of spontaneous circulation, aiming to evaluate various predictive scores and their accuracy in anticipating neurological outcomes after 90 days.
- Among the 658 patients analyzed, results showed a 63% mortality rate and noted that while Utstein criteria had moderate predictive capability (AUROC of 0.79), other scores demonstrated a range of performance, with some showing
Article Synopsis
- The study focused on immunocompromised patients with acute respiratory failure (ARF) to understand the significance of detecting respiratory viruses in nasopharyngeal swabs.
- It involved analyzing data from 510 patients, with 20.2% testing positive for respiratory viruses, predominantly flu-like viruses, and noted a significant relationship between virus detection and the identified causes of ARF.
- However, no difference was observed in 28-day mortality or the need for invasive mechanical ventilation based on positive viral assay results, although flu-like virus detection correlated with worse outcomes in patients who had received stem cell transplants.
Background: Immune checkpoint inhibitors (ICI) have transformed cancer treatment over the last decade. Alongside this therapeutic improvement, a new variety of side effects has emerged, called immune-related adverse events (irAEs), potentially affecting any organ. Among these irAEs, myocarditis is rare but life-threatening.
View Article and Find Full Text PDFObjectives: The use of extended intermittent infusion (EII) or continuous infusion (CI) of meropenem is recommended in intensive care unit (ICU) patients, but few data comparing these two options are available. This retrospective cohort study was conducted between 1 January 2019 and 31 March 2020 in a teaching hospital ICU. It aimed to determine the meropenem plasma concentrations achieved with CI and EII.
View Article and Find Full Text PDFBackground: Necrotizing soft tissue infections (NSTIs) are rare life-threatening bacterial infections. Few data are available regarding neutropenic patients with NSTIs. Our objectives were to describe the characteristics and management of neutropenic patients with NSTIs in intensive care units (ICUs).
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- This study aimed to understand the outcomes of patients with severe meningoencephalitis in intensive care, analyzing data from 599 adults across 68 medical centers in 7 countries from 2017 to 2020.
- Results showed that more than half of the patients (50.5%) had poor functional outcomes at three months, with 25.8% resulting in death; causes of meningoencephalitis were varied, with acute bacterial meningitis being the most common.
- Key factors linked to worse outcomes included being older than 60, having a weakened immune system, delays in ICU admission, and severe neurological impairments, highlighting the need for timely care and monitoring.
Background: The rise in antimicrobial resistance is a global threat responsible for about 33,000 deaths in 2015 with a particular concern for extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) and has led to a major increase in the use of carbapenems, last-resort antibiotics.
Methods: In this retrospective propensity-weighted multicenter observational study conducted in 11 ICUs, the purpose was to assess the efficacy of non carbapenem regimen (piperacillin-tazobactam (PTZ) + aminoglycosides or 3rd-generation cephalosporin (3GC) + aminoglycosides) as empiric therapy in comparison with carbapenem in extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) urinary septic shock. The primary outcome was Day-30 mortality.
Isavuconazole is a triazole antifungal agent recently recommended as first-line therapy for invasive pulmonary aspergillosis. With the COVID-19 pandemic, cases of COVID-19-associated pulmonary aspergillosis (CAPA) have been described with a prevalence ranging from 5 to 30%. We developed and validated a population pharmacokinetic (PKpop) model of isavuconazole plasma concentrations in intensive care unit patients with CAPA.
View Article and Find Full Text PDFObjectives: The objective of this prospective, single-center study was to explore the mid-term outcomes 6 to 9 months after hospitalization in an Intensive Care Unit (ICU) for severe COVID-19 infection.
Methods: Patients systematically underwent biological tests, pulmonary function tests, chest computed tomography (CT) scan, and psychological tests.
Results: Among 86 patients, including 71 (82.
Objectives: We aimed at assessing the efficacy and safety on antibiotic exposure of a strategy combining a respiratory multiplex PCR (mPCR) with enlarged panel and daily procalcitonin (PCT) measurements, as compared with a conventional strategy, in adult patients who were critically ill with laboratory-confirmed SARS-CoV-2 pneumonia.
Methods: This multicentre, parallel-group, open-label, randomized controlled trial enrolled patients admitted to 13 intensive care units (ICUs) in France. Patients were assigned (1:1) to the control strategy, in which antibiotic streamlining remained at the discretion of the physicians, or interventional strategy, consisting of using mPCR and daily PCT measurements within the first 7 days of randomization to streamline initial antibiotic therapy, with antibiotic continuation encouraged when PCT was >1 ng/mL and discouraged if < 1 ng/mL or decreased by 80% from baseline.
Introduction: The prognostic significance of the thrombin generation assay (TGA) with a thrombomodulin (TM) challenge in patients entering hospital with severe COVID-19 is uncertain.
Methods: We prospectively evaluated an automated TGA (aTGA) using the ST-ThromboScreen® assay and ST-Genesia® analyser in 179 patients with severe COVID-19 during their admission to 2 university hospitals. The primary outcome was early survival at Day 28 (D28).
Background: A higher sodium (Na) dialysate concentration is recommended during renal replacement therapy (RRT) of acute kidney injury (AKI) to improve intradialytic hemodynamic tolerance, but it may lead to Na loading to the patient. We aimed to evaluate Na flux according to Na dialysate and infusate concentrations at 140 and 145 mmol/L during hemodialysis (HD) and hemodiafiltration (HDF).
Methods: Fourteen AKI patients that underwent consecutive HD or HDF sessions with Na dialysate/infusate at 140 and 145 mmol/L were included.