Publications by authors named "Nicolas Brechot"
Innate immune response in acute critical illness: a narrative review.
Ann Intensive Care
September 2024
Background: Activation of innate immunity is a first line of host defense during acute critical illness (ACI) that aims to contain injury and avoid tissue damages. Aberrant activation of innate immunity may also participate in the occurrence of organ failures during critical illness. This review aims to provide a narrative overview of recent advances in the field of innate immunity in critical illness, and to consider future potential therapeutic strategies.
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- Severe thrombotic antiphospholipid syndrome (APS) significantly affects critical organs and has not been thoroughly studied in ICU patients, particularly regarding hematological issues.
- A retrospective study in France tracked 134 APS patients in ICUs, revealing high rates of anemia (95%) and thrombocytopenia (93%), with low platelet counts linked to increased mortality.
- The findings highlight the importance of understanding the causes of thrombocytopenia in APS patients, as conditions like thrombotic microangiopathy (TMA), heparin-induced thrombocytopenia (HIT), and disseminated intravascular coagulation (DIC) are prevalent in this population.
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- Hypoxic ischemic brain injury (HIBI) affects brain areas crucial for the autonomic nervous system, and researchers aimed to find how heart rate variability (HRV) can predict neurological outcomes after cardiac arrest (CA).
- The study included 199 patients who experienced CA, focusing on the correlation between HRV markers and the severity of brain injury, along with other prognostic indicators like EEG results and pupillary reflexes.
- Findings revealed that patients with better neurological outcomes had significantly higher HRV values, particularly in very low and low frequencies, as well as in the LF/HF ratio, indicating that these HRV measurements may serve as useful predictors for recovery.
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- Management of dual antiplatelet therapy (DAPT) in VA-ECMO patients post-acute myocardial infarction (AMI) presents challenges, with significant occurrences of severe bleeding and coagulation issues.
- A study analyzed 176 post-AMI patients on VA-ECMO, finding nearly 39% experienced severe bleeding and a high mortality rate of 49%.
- Factors such as female sex, duration on ECMO, and certain biomarkers were linked to an increased risk of severe bleeding, which led to the discontinuation of antiplatelet therapy in one-third of the cases.
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- Fulminant myocarditis is a serious condition that requires accurate diagnosis, typically through a myocardial biopsy, but the procedure carries risks, and its effectiveness for treatment is unclear.
- A study at a French ICU examined patients who were on mechanical circulatory support (MCS) and underwent biopsy, finding that while the diagnosis of definite myocarditis increased significantly after biopsy, the actual change in treatment was minimal.
- The study concluded that the risks associated with myocardial biopsy may outweigh its benefits in these vulnerable patients, suggesting a need for more caution in deciding to perform the procedure.
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- Vascular leakage is a key issue in ARDS, especially in COVID-19 patients, and the study aimed to test FX06, a drug meant to stabilize blood vessel junctions, for its effectiveness in reducing this leakage.
- In a double-blinded trial with 49 adults on mechanical ventilation, participants received either FX06 or a placebo, but results showed no difference in lung-water levels or other key measures between the two groups after 7 days.
- Although FX06 did not reduce vascular leakage, it was associated with a higher incidence of ventilator-associated pneumonia, indicating the need for further studies to assess its timing and dosing for better results.
In the human body, the 10 blood endothelial cells (ECs) which cover a surface of 500-700 m (Mai et al., 2013) are key players of tissue homeostasis, remodeling and regeneration. Blood vessel ECs play a major role in the regulation of metabolic and gaz exchanges, cell trafficking, blood coagulation, vascular tone, blood flow and fluid extravasation (also referred to as blood vascular permeability).
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- Outcomes for patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) differ significantly based on the underlying cause of their shock, with a study from a Paris hospital analyzing over 1,200 cases from 2015 to 2018.
- The research found that hospital survival rates ranged from 11.1% for refractory vasoplegia shock to 73.3% for primary graft failure, highlighting the varying severity and long-term survival prospects tied to different etiologies of shock.
- Complications such as renal failure, neurological issues, and pulmonary edema were noted, emphasizing the importance of understanding both immediate and long-term patient outcomes based on the specific cause of shock.*
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- The study investigates the use of Venoarterial extracorporeal membrane oxygenation (VA-ECMO) in patients with refractory cardiogenic shock, focusing on determining optimal flow rates and identifying risk factors for high ECMO flow.
- Out of 209 patients analyzed over seven years, 50% were classified as 'high-flow', exhibiting more severe conditions at admission compared to the 'low-flow' group.
- The findings revealed that while high-flow patients experienced more complications and a higher incidence of ventilator-associated pneumonia, there was no significant difference in overall lengths of stay or survival rates between the two groups.
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- The study investigates the outcomes of critically ill pregnant women with severe ARDS who underwent ECMO, focusing on whether the timing of delivery (before or after ECMO) affects maternal and fetal health.
- Out of 563 women, those whose delivery was performed after ECMO faced higher rates of major bleeding, while fetal survival rates were significantly better when ECMO was started post-delivery.
- Despite risks, overall maternal survival rates were high, and newborns showed no severe complications or long-term health issues, indicating the need for careful decision-making regarding delivery timing in these critical cases.
Background: Lung reactivations of Herpesviridae, herpes simplex virus (HSV) and cytomegalovirus (CMV) have been reported in COVID-19 patients. Whether or not those viral reactivations are more frequent than in other patients is not known.
Methods: Retrospective monocentric cohort study of 145 patients with severe COVID-19 pneumonia requiring invasive mechanical ventilation and who were tested for HSV and CMV in bronchoalveolar lavage performed during fiberoptic bronchoscopy for ventilator-associated pneumonia suspicion.
Article Synopsis
- - The study examines adults suffering from fulminant myocarditis related to COVID-19, identifying two distinct groups: those meeting multisystem inflammatory syndrome criteria (MIS-A) and those who do not.
- - Out of 38 patients analyzed, 66% met the MIS-A criteria, with significant differences in clinical outcomes; those with MIS-A exhibited higher in-hospital mortality (31% vs. 4%) and more severe organ failure.
- - Biological markers also varied between the groups, suggesting differing underlying inflammatory processes, which could impact treatment approaches in future cases of COVID-19-related myocarditis.
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- Post-intensive care syndrome (PICS) is a condition that causes lasting physical, cognitive, and mental impairments after leaving the ICU, significantly affecting patients' long-term health and quality of life.
- The review discusses key issues related to PICS, including muscle weakness, cognitive deficits associated with delirium, and long-term effects on the immune system, kidneys, and lungs.
- Understanding the biological processes underlying PICS can lead to improved patient care and new strategies for prevention and treatment.
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- The study explores the effects of increasing VA ECMO flow and dobutamine dosage on microcirculation in patients with refractory cardiogenic shock who are stabilized on ECMO.
- A total of 14 intubated patients were involved in the interventional study, with assessments of macro- and microcirculations conducted after adjusting dobutamine doses and ECMO flows.
- Results showed that increasing dobutamine doses did not impact microcirculation parameters, while only a slight improvement in the De Backer score was observed with increased ECMO flow, indicating no additional microcirculatory benefits beyond a certain point.
Objectives: Systemic rheumatic diseases (SRDs) are a group of inflammatory disorders that can need intensive care unit (ICU) admission during a flare-up, requiring administration of immunosuppressants. We undertook this study to determine the frequency, outcome, and occurrence associated factors of infections in flare-up SRD patients receiving immunosuppressant.
Methods: Monocenter, a retrospective study including SRD patients admitted to ICU for a flare-up requiring immunosuppressant from 2004 to 2019.
Background: Amniotic fluid embolism (AFE) is a rare but often catastrophic complication of pregnancy that leads to cardiopulmonary dysfunction and severe disseminated intravascular coagulopathy (DIC). Although few case reports have reported successful use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) with AFE, concerns can be raised about the increased bleeding risks with that device.
Methods: This study included patients with AFE rescued by VA-ECMO hospitalized in two high ECMO volume centers between August 2008 and February 2021.
Background: In-hospital cardiac arrest(IHCA) has received little attention compared with out-of-hospital cardiac arrest.
Aim: To address the paucity of data on IHCA patients, we examined key features, variations in mortality and predictors of death among patients admitted in French intensive care units(ICUs) from 1997 to 2015.
Methods: Using the database of the Collège des Utilisateurs de Bases de données en Réanimation(CUB-Réa) that prospectively collects data from ICUs in the greater Paris area, we determined temporal trends in the incidence of IHCA, patients' outcomes, crude and Simplified Acute Physiology Score(SAPS)-II Standardized mortality and predictors of in-ICU mortality.
Viral Ventilator-Associated Pneumonia/Hospital-Acquired Pneumonia.
Semin Respir Crit Care Med
April 2022
Among the viruses possibly responsible for hospital-acquired and ventilator-associated pneumonia, herpes simplex virus (HSV) is probably the most often involved: HSV reactivation is frequent in intensive care unit patients, and lung parenchymal infection (HSV bronchopneumonitis) has been well described, either using cytological signs of parenchymal involvement in cells obtained during bronchoalveolar lavage or using HSV virus load in the lower respiratory tract. Although treating patients with HSV bronchopneumonitis may be recommended, based on expert opinion, prophylactic or preemptive treatment of HSV reactivation should be avoided. Ventilator-associated pneumonia due to cytomegalovirus (CMV) is less frequent than HSV bronchopneumonitis, and more difficult to diagnose.
View Article and Find Full Text PDFWhile multiple pharmacological drugs have been associated with myocarditis, temporal trends and overall mortality have not been reported. Here we report the spectrum and main features of 5108 reports of drug-induced myocarditis, in a worldwide pharmacovigilance analysis, comprising more than 21 million individual-case-safety reports from 1967 to 2020. Significant association between myocarditis and a suspected drug is assessed using disproportionality analyses, which use Bayesian information component estimates.
View Article and Find Full Text PDFBackground: Extracorporeal cardiopulmonary resuscitation (ECPR) is a rescue therapy for refractory cardiac arrest, but its high mortality has raised questions about patient selection. No selection criteria have been proposed for patients experiencing in-hospital cardiac arrest. We aimed to identify selection criteria available at the time ECPR was considered for patients with in-hospital cardiac arrest.
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- Postoperative Candida mediastinitis is a rare but severe complication following cardiac surgery, leading to high mortality rates among critically ill patients, with a one-year survival probability of only 40% after ICU admission.
- A case-control study matched 40 patients with Candida mediastinitis to 40 with bacterial mediastinitis, considering factors like age and use of invasive devices; results showed that patients with Candida had significantly lower survival rates.
- The study found that renal replacement therapy and Candida mediastinitis are independently linked to higher mortality risk within one year, highlighting the need for careful management of such infections in the postoperative setting.
Background: Extracorporeal membrane oxygenation (ECMO) was frequently used to treat patients with severe coronavirus disease-2019 (COVID-19)-associated acute respiratory distress (ARDS) during the initial outbreak. Care of COVID-19 patients evolved markedly during the second part of 2020. Our objective was to compare the characteristics and outcomes of patients who received ECMO for severe COVID-19 ARDS before or after July 1, 2020.
View Article and Find Full Text PDFObjectives: The impact of bronchoalveolar lavage on regional ventilation in mechanically ventilated patients with acute respiratory distress syndrome has rarely been described. Our objectives were use electrical impedance tomography to describe lung impedance variation post bronchoalveolar lavage and identify morphologic patterns according to respiratory failure severity.
Design: Monocenter physiologic study on mechanically ventilated patients.