Publications by authors named "Michel Sirodot"
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 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.
Background: Outcomes of postresuscitation shock after cardiac arrest can be affected by targeted temperature management (TTM). A post hoc analysis of the "TTM1 trial" suggested higher mortality with hypothermia at 33 °C. We performed a post hoc analysis of HYPERION trial data to assess potential associations linking postresuscitation shock after non-shockable cardiac arrest to hypothermia at 33 °C on favourable functional outcome.
View Article and Find Full Text PDFBackground: Targeted temperature management (TTM) currently is the only treatment with demonstrated efficacy in attenuating the harmful effects on the brain of ischemia-reperfusion injury after cardiac arrest. However, whether TTM is beneficial in the subset of patients with in-hospital cardiac arrest (IHCA) remains unclear.
Research Question: Is TTM at 33 °C associated with better neurological outcomes after IHCA in a nonshockable rhythm compared with targeted normothermia (TN; 37 °C)?
Study Design And Methods: We performed a post hoc analysis of data from the published Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm randomized controlled trial in 584 patients.
Purpose: Acute mesenteric ischemia (AMI) is a rare, but life-threatening condition occurring among critically ill patients. Several factors have been associated with AMI, but the causal link is debated, most studies being retrospective. Among these factors, enteral nutrition (EN) could be associated with AMI, in particular among patients with shock.
View Article and Find Full Text PDFBackground: Few data are available about outcomes of patients screened for, but not enrolled in, randomised clinical trials.
Methods: We retrospectively reviewed patients who had non-inclusion criteria for the HYPERION trial comparing 33 °C to 37 °C in patients comatose after cardiac arrest in non-shockable rhythm, due to any cause. A good neurological outcome was defined as a day-90 Cerebral Performance Category score of 1 or 2.
Introduction: International guidelines include early nutritional support (≤48 hour after admission), 20-25 kcal/kg/day, and 1.2-2 g/kg/day protein at the acute phase of critical illness. Recent data challenge the appropriateness of providing standard amounts of calories and protein during acute critical illness.
View Article and Find Full Text PDFBackground: Patients with obesity are at higher risk for community-acquired and nosocomial infections. However, no study has specifically evaluated the relationship between obesity and ventilator-associated pneumonia (VAP).
Research Question: Is obesity associated with an increased incidence of VAP?
Study Design And Methods: This study was a post hoc analysis of the Impact of Early Enteral vs Parenteral Nutrition on Mortality in Patients Requiring Mechanical Ventilation and Catecholamines (NUTRIREA2) open-label, randomized controlled trial performed in 44 French ICUs.
Purpose: To report the incidence, risk factors, clinical presentation, and outcome predictors of severe leptospirosis requiring intensive care unit (ICU) admission in a temperate zone.
Methods: LEPTOREA was a retrospective multicentre study conducted in 79 ICUs in metropolitan France. Consecutive adults admitted to the ICU for proven severe leptospirosis from January 2012 to September 2016 were included.
Background: Moderate therapeutic hypothermia is currently recommended to improve neurologic outcomes in adults with persistent coma after resuscitated out-of-hospital cardiac arrest. However, the effectiveness of moderate therapeutic hypothermia in patients with nonshockable rhythms (asystole or pulseless electrical activity) is debated.
Methods: We performed an open-label, randomized, controlled trial comparing moderate therapeutic hypothermia (33°C during the first 24 hours) with targeted normothermia (37°C) in patients with coma who had been admitted to the intensive care unit (ICU) after resuscitation from cardiac arrest with nonshockable rhythm.
Purpose: The effects of the route of nutrition on the gut mucosa of patients with shock are unclear. Plasma citrulline concentration is a marker of enterocyte mass, and plasma intestinal fatty acid binding protein (I-FABP) concentration is a marker of enterocyte damage. We aimed to study the effect of the route of nutrition on plasma citrulline concentration measured at day 3 of nutrition.
View Article and Find Full Text PDFBackground: Microaspiration of gastric and oropharyngeal secretions is the main mechanism of entry of bacteria into the lower respiratory tract in intubated critically ill patients. The aim of this study is to determine the impact of enteral nutrition, as compared with parenteral nutrition, on abundant microaspiration of gastric contents and oropharyngeal secretions.
Methods: Planned ancillary study of the randomized controlled multicenter NUTRIREA2 trial.
Background: Whether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than with early first-line parenteral nutrition.
Methods: In this randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2 trial) done at 44 French intensive-care units (ICUs), adults (18 years or older) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned (1:1) to either parenteral nutrition or enteral nutrition, both targeting normocaloric goals (20-25 kcal/kg per day), within 24 h after intubation.
Background: Different modes of death are described in selected populations, but few data report the characteristics of death in a general intensive care unit population. This study analyzed the causes and characteristics of death of critically ill patients and compared anticipated death patients to unexpected death counterparts.
Methods: An observational multicenter cohort study was performed in 96 intensive care units.
Background: Meta-analyses of nonrandomized studies have provided conflicting data on therapeutic hypothermia, or targeted temperature management (TTM), at 33°C in patients successfully resuscitated after nonshockable cardiac arrest. Nevertheless, the latest recommendations issued by the International Liaison Committee on Resuscitation and by the European Resuscitation Council recommend therapeutic hypothermia. New data are available on the adverse effects of therapeutic hypothermia, notably infectious complications.
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- * This multicenter, randomized controlled trial will recruit 2,854 patients, randomly assigning them to receive either EN or PN, starting nutritional support within 24 hours of IMV initiation.
- * The findings from this study could provide important insights into optimal nutritional strategies in ICUs, potentially impacting guidelines for patient care and survival outcomes.
Article Synopsis
- - Timely identification of bacterial infections and effective antimicrobial treatments are crucial for critically ill patients in the ICU; however, advanced diagnostic techniques remain costly and inaccessible in many facilities.
- - The rising resistance to antimicrobials, particularly among Gram-negative bacteria, poses significant risks, leading ICU physicians to use combination therapies that may inadvertently foster even more resistance.
- - Implementing multidisciplinary antimicrobial stewardship programs is essential for optimizing antibiotic prescriptions, addressing challenges, and ultimately improving patient outcomes to prevent future difficulties with infections in the ICU.
Article Synopsis
- Despite the potential benefits of induced hypothermia in treating severe bacterial meningitis, a clinical trial showed it may actually increase mortality rates compared to standard care in comatose patients.
- The trial, conducted in France, involved 98 patients with community-acquired bacterial meningitis, who were either cooled to between 32°C to 34°C or received standard treatment.
- The trial was halted early due to significant excess mortality in the hypothermia group, with 51% of patients dying compared to 31% in the control group, raising concerns about the safety of this intervention.
Background: Previous trials involving patients with the acute respiratory distress syndrome (ARDS) have failed to show a beneficial effect of prone positioning during mechanical ventilatory support on outcomes. We evaluated the effect of early application of prone positioning on outcomes in patients with severe ARDS.
Methods: In this multicenter, prospective, randomized, controlled trial, we randomly assigned 466 patients with severe ARDS to undergo prone-positioning sessions of at least 16 hours or to be left in the supine position.
Context: A recent trial showed that placing patients with acute lung injury in the prone position did not increase survival; however, whether those results hold true for patients with hypoxemic acute respiratory failure (ARF) is unclear.
Objective: To determine whether prone positioning improves mortality in ARF patients.
Design, Setting, And Patients: Prospective, unblinded, multicenter controlled trial of 791 ARF patients in 21 general intensive care units in France using concealed randomization conducted from December 14, 1998, through December 31, 2002.