Publications by authors named "Thibaut Genty"
Objectives: Prone positioning (PP) has benefits in patients with acute respiratory distress syndrome. The objective of this study was to compare the effects and complications of PP in obese versus non-obese patients with moderate-to-severe acute respiratory distress syndrome after cardiothoracic surgery.
Methods: We retrospectively analysed a database established in 2014-2021 in an intensive care unit.
Effect of Deep Hypothermia (18°C) on Dioxygen Metabolism During Pulmonary Thromboendarterectomy Surgery.
J Cardiothorac Vasc Anesth
December 2024
Article Synopsis
- This study aimed to assess how deep hypothermia affects oxygen extraction (OE) and oxygen consumption (VO) in patients undergoing a specific heart surgery at different temperatures (normothermic, 30°C, 25°C, and 18°C).
- Over 3 months, 24 patients' hemodynamic and blood gas data were collected, revealing significant decreases in VO (from 65.9 to 25.1 mL O/min/m) and OE (from 18% to 9%) as temperature dropped to 18°C.
- The results indicate that metabolic needs are primarily met by dissolved oxygen during the cooling phase, highlighting the importance of increasing arterial oxygen pressure to prevent hypoxia in patients undergoing deep hyp
Background: Gastrointestinal ischemia (GIisch) is challenging to diagnose in patients after cardiothoracic surgery. Computed tomography angiography (CTA) carries substantial false-negative and false-positive rates. The aim of the study was to evaluate if a combination of readily available variables improves the diagnosis of GIisch after cardiothoracic surgery.
View Article and Find Full Text PDFBackground: Endomyocardial biopsies (EMB) are recommended for the detection of acute cardiac rejection (ACR) despite limited sensitivity. We report the long-term post-transplant results of Doppler echocardiography as a noninvasive alternative of routine EMB.
Methods: Two cohorts of heart transplantation (HT) recipients were chronologically defined as follows: the Dual Monitoring Cohort (DMC) from January 1990 to December 1997 included patients who underwent routine EMB and Doppler echocardiography within 24 hours for ACR surveillance; and the "Echo-First Cohort" (EFC), including patients transplanted from January 1998 to December 2018 with Doppler echocardiography as first-line approach for ACR surveillance.
Background: Bleeding and thrombosis induce major morbidity and mortality in patients under extracorporeal membrane oxygenator (ECMO). Circuit changes can be performed for oxygenation membrane thrombosis but are not recommended for bleeding under ECMO. The objective of this study was to evaluate the course of clinical, laboratory, and transfusion parameters before and after ECMO circuit changes warranted by bleeding or thrombosis.
View Article and Find Full Text PDFBackground: Clinical diagnosis of ICU-acquired pneumonia after cardiothoracic surgery is challenging. Johanson criteria (chest radiograph infiltrate, purulent tracheal secretions, fever, and leukocytosis) fail in half the cases. A high Clinical Pulmonary Infection Score (CPIS) and ≥ 2-point increase in Sequential Organ Failure Assessment (SOFA) score (SOFA↑ ≥ 2) may improve diagnosis.
View Article and Find Full Text PDFObjective: The aim of this prospective longitudinal study was to compare driving pressure and absolute PaO/FiO ratio in determining the best positive end-expiratory pressure (PEEP) level.
Patients And Methods: In 122 patients with acute respiratory distress syndrome, PEEP was increased until plateau pressure reached 30 cmHO at constant tidal volume, then decreased at 15-min intervals, to 15, 10, and 5 cmHO. The best PEEP by PaO/FiO ratio (PEEP) was defined as the highest PaO/FiO ratio obtained, and the best PEEP by driving pressure (PEEP) as the lowest driving pressure.
Background: Successful extubation is difficult to predict. Ultrasound measurement of the diaphragm thickening fraction (DTF) might help predict weaning failure after cardiothoracic surgery.
Methods: We assessed the predictive performance of diaphragm ultrasound in a derivation cohort of 50 prospectively included cardiothoracic surgery subjects ready for a weaning trial and in a validation cohort of 39 subjects ventilated for ≥ 48 h.
Background: Obesity may increase the risk of respiratory failure after cardiothoracic surgery. A recruitment maneuver followed by PEEP might decrease the risk of respiratory failure in obese subjects. We hypothesized that the routine use after heart surgery of a recruitment maneuver followed by high or low PEEP level would decrease the frequency of respiratory failure in obese subjects.
View Article and Find Full Text PDFBackground: Whether train-of-four (TOF) monitoring is more effective than clinical monitoring to guide neuromuscular blockade (NMB) in patients with acute respiratory distress syndrome (ARDS) is unclear. We compared clinical monitoring alone or with TOF monitoring to guide atracurium dosage adjustment with respect to drug dose and respiratory parameters.
Methods: From 2015 to 2016, we conducted a randomized controlled trial comparing clinical assessments every 2 hours with or without corrugator supercilii TOF monitoring every 4 hours in patients who developed ARDS (Pao2/Fio2 <150 mm Hg) in a cardiothoracic intensive care unit.
Objective: To compare the respiratory workload using the diaphragm thickening fraction (DTf) determined by sonography during high-flow nasal oxygen (HFNO), standard oxygen therapy (SOT), and noninvasive bilevel positive airway pressure support (BIPAP) in patients with acute respiratory failure (ARF) after cardiothoracic surgery.
Design: Prospective controlled clinical trial.
Setting: A French 23-bed cardiothoracic surgical intensive care unit.