Objective To develop French guidelines on the management of patients with severe abdominal trauma... more Objective To develop French guidelines on the management of patients with severe abdominal trauma. Design A consensus committee of 20 experts from the French Society of Anaesthesiology and Critical Care Medicine (Société française d’anesthésie et de réanimation, SFAR), the French Society of Emergency Medicine (Société française de médecine d’urgence, SFMU), the French Society of Urology (Société française d’urologie, SFU) and from the French Association of Surgery (Association française de chirurgie, AFC), the Val-de-Grâce School (École du Val-De-Grâce, EVG) and the Federation for Interventional Radiology (Fédération de radiologie interventionnelle, FRI-SFR) was convened. Declaration of all conflicts of interest (COI) policy by all participants was mandatory throughout the development of the guidelines. The entire guideline process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Deve...
Mild traumatic brain injury (mTBI) can induce long-term behavioral and cognitive disorders. Altho... more Mild traumatic brain injury (mTBI) can induce long-term behavioral and cognitive disorders. Although the exact origin of these mTBI-related disorders is not known, they may be the consequence of diffuse axonal injury (DAI). Here, we investigated whether MRI at the subacute stage can detect lesions that are associated with poor functional outcome in mTBI by using anatomical images (T 1) and diffusion tensor imaging (DTI). Twenty-three patients with mTBI were investigated and compared with 23 healthy volunteers. All patients underwent an MRI investigation and clinical tests between 7 and 28 days (D15) and between 3 and 4 months (M3) after injury. Patients were divided in two groups Contract grant sponsors: IRME (Institut pour la Recherche sur la Moelle Epinière et l'Encéphale), GMF (Garantie Mutuelle des Fonctionnaires).
Despite a stringent donor selection, human islet isolation remains frustratingly unpredictable. I... more Despite a stringent donor selection, human islet isolation remains frustratingly unpredictable. In this study, we measured acute insulin response to arginine (AIRarg), an in vivo surrogate measure of islet mass, in 29 human deceased donors before organ donation, and correlated values with the outcome of islet isolation. Thirteen isolations (45%) met the threshold for clinical islet transplantation. Among all measured donor characteristics, the only discriminating variable between successful or unsuccessful isolations was donor AIRarg (p < 0.01). Using a threshold of 55 microIU/mL (ROC curve AUC: 72%), isolation was successful in 12/19 donors with high AIRarg and in 1/10 donors with low AIRarg (p < 0.001). The negative and positive predictive values were 90 and 63%, respectively. If used to select donors in the entire cohort, AIRarg would have increased our success rate by 40% and avoided 56% of unsuccessful isolations while missing only 8% of successful preparations. Our results suggest that donor AIRarg is markedly superior to body mass index (BMI) and other criteria currently used to predict isolation outcome. If routinely performed in deceased donors, this simple test could significantly reduce the failure rate of human islet isolation.
Background Trauma-induced coagulopathy includes thrombocytopenia and platelet dysfunction that im... more Background Trauma-induced coagulopathy includes thrombocytopenia and platelet dysfunction that impact patient outcome. Nevertheless, the role of platelet transfusion remains poorly defined. The aim of the study was 1/ to evaluate the impact of early platelet transfusion on 24-h all-cause mortality and 2/ to describe platelet count at admission (PCA) and its relationship with trauma severity and outcome. Methods Observational study carried out on a multicentre prospective trauma registry. All adult trauma patients directly admitted in participating trauma centres between May 2011 and June 2019 were included. Severe haemorrhage was defined as ≥ 4 red blood cell units within 6 h and/or death from exsanguination. The impact of PCA and early platelet transfusion (i.e. within the first 6 h) on 24-h all-cause mortality was assessed using uni- and multivariate logistic regression. Results Among the 19,596 included patients, PCA (229 G/L [189,271]) was associated with coagulopathy, traumatic...
lyophilized plasma versus fresh frozen plasma for the initial management of trauma-induced coagul... more lyophilized plasma versus fresh frozen plasma for the initial management of trauma-induced coagulopathy: a randomized open-label trial.
Résultats. -Cinq cent quarante-deux patients ont été inclus. L'âge moyen était de 42 AE 20 ans, l... more Résultats. -Cinq cent quarante-deux patients ont été inclus. L'âge moyen était de 42 AE 20 ans, le ratio H/F de 4/1. La répartition des GCS était 26 % de GCS 3, 23 % de GCS 4-5 et 46 % de GCS 6-8. Les polytraumatisés étaient 60 % (n = 401) dont 15 % en état de choc (n = 79). Au moins un mydriase aréactive a été retrouvée chez 25 % des patients (n = 137) et 58 % d'entre eux (n = 80) ont bénéficié d'une osmothérapie. Pendant les 48 premières heures, 24 % des patients ont eu un épisode d'hypotension, 26 % un épisode d'hypoxémie et 5 % une anémie. Les délais d'arrivée à l'hôpital étaient de 114 AE 38 minutes et 77 % des patients ont été hospitalisés dans un centre traumatologique spécialisé. Un bloc neurochirurgical urgent a été nécessaire chez 12 % des TCG. La mortalité observée à 48 heures était de 28 % (n = 148). En analyse multivariée, le risque de décès est lié à l'âge, à l'anémie (risque  3), à l'hypotension artérielle (risque  10) et à l'absence d'osmothérapie pendant une mydriase aréactive (risque  18). Conclusion. -Le contrôle de la pression artérielle, le
... Unité de réanimation chirurgicale CHU Bicêtre, Le Kremlin-Bicêtre ; Pr Bruno Riou, Dr Daniell... more ... Unité de réanimation chirurgicale CHU Bicêtre, Le Kremlin-Bicêtre ; Pr Bruno Riou, Dr Danielle Sartorius, Dr Yan Zhao, Service d'accueil des urgences, Pr Olivier Langeron, Dr Frédéric Marmion, Dr ... Riou B, Carli P, Thicoïpé M, Atain-Kouadio P (2003) Comment évaluer la gravité ...
127 F-AM White matter lesions localisation and clinical outcome in severe traumatic brain injury:... more 127 F-AM White matter lesions localisation and clinical outcome in severe traumatic brain injury: a DTI study,
A better understanding of the natural history of intracerebral haemorrhages (ICH) with cohorts re... more A better understanding of the natural history of intracerebral haemorrhages (ICH) with cohorts representing the whole spectrum of the disease is necessary to improve treatment. Our aim was to identify potential differences in baseline characteristics and short-term outcomes of patients with non-traumatic ICH, included in a hospital- and in a population-based stroke registry. We compared 373 patients recruited in a university hospital and the last 373 ICH patients included in a population-based registry. Both cohorts included consecutive patients with non-traumatic parenchymal haemorrhages. In the hospital cohort, we collected data from all patients admitted in the emergency room, irrespective of the clinical severity and of the specialist in charge of the patient.In the hospital cohort, patients were younger and more often alcoholic, but these differences may be explained by the younger age and a higher prevalence of alcoholism in this area. Patients also had more frequently hypercholesterolemia, and were more often under antiplatelet therapy. Both cohorts did not differ for intra-hospital casefatality rate.The characteristics of patients included in the hospital cohort were very close to those of patients from a population-based registry, and the differences observed are likely to be explained by differences in the characteristics of the populations in the two areas and different periods of recruitment. Recruiting patients in emergency rooms, and not in stroke units, neurological, or neurosurgical departments, has enabled us to build a cohort of ICH patients representative of the whole spectrum of the disease, with minimised recruitment bias and maximised precision of the variables collected. This cohort may, therefore, provide reliable information on the natural history of ICH.
Objective To develop French guidelines on the management of patients with severe abdominal trauma... more Objective To develop French guidelines on the management of patients with severe abdominal trauma. Design A consensus committee of 20 experts from the French Society of Anaesthesiology and Critical Care Medicine (Société française d’anesthésie et de réanimation, SFAR), the French Society of Emergency Medicine (Société française de médecine d’urgence, SFMU), the French Society of Urology (Société française d’urologie, SFU) and from the French Association of Surgery (Association française de chirurgie, AFC), the Val-de-Grâce School (École du Val-De-Grâce, EVG) and the Federation for Interventional Radiology (Fédération de radiologie interventionnelle, FRI-SFR) was convened. Declaration of all conflicts of interest (COI) policy by all participants was mandatory throughout the development of the guidelines. The entire guideline process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Deve...
Mild traumatic brain injury (mTBI) can induce long-term behavioral and cognitive disorders. Altho... more Mild traumatic brain injury (mTBI) can induce long-term behavioral and cognitive disorders. Although the exact origin of these mTBI-related disorders is not known, they may be the consequence of diffuse axonal injury (DAI). Here, we investigated whether MRI at the subacute stage can detect lesions that are associated with poor functional outcome in mTBI by using anatomical images (T 1) and diffusion tensor imaging (DTI). Twenty-three patients with mTBI were investigated and compared with 23 healthy volunteers. All patients underwent an MRI investigation and clinical tests between 7 and 28 days (D15) and between 3 and 4 months (M3) after injury. Patients were divided in two groups Contract grant sponsors: IRME (Institut pour la Recherche sur la Moelle Epinière et l'Encéphale), GMF (Garantie Mutuelle des Fonctionnaires).
Despite a stringent donor selection, human islet isolation remains frustratingly unpredictable. I... more Despite a stringent donor selection, human islet isolation remains frustratingly unpredictable. In this study, we measured acute insulin response to arginine (AIRarg), an in vivo surrogate measure of islet mass, in 29 human deceased donors before organ donation, and correlated values with the outcome of islet isolation. Thirteen isolations (45%) met the threshold for clinical islet transplantation. Among all measured donor characteristics, the only discriminating variable between successful or unsuccessful isolations was donor AIRarg (p < 0.01). Using a threshold of 55 microIU/mL (ROC curve AUC: 72%), isolation was successful in 12/19 donors with high AIRarg and in 1/10 donors with low AIRarg (p < 0.001). The negative and positive predictive values were 90 and 63%, respectively. If used to select donors in the entire cohort, AIRarg would have increased our success rate by 40% and avoided 56% of unsuccessful isolations while missing only 8% of successful preparations. Our results suggest that donor AIRarg is markedly superior to body mass index (BMI) and other criteria currently used to predict isolation outcome. If routinely performed in deceased donors, this simple test could significantly reduce the failure rate of human islet isolation.
Background Trauma-induced coagulopathy includes thrombocytopenia and platelet dysfunction that im... more Background Trauma-induced coagulopathy includes thrombocytopenia and platelet dysfunction that impact patient outcome. Nevertheless, the role of platelet transfusion remains poorly defined. The aim of the study was 1/ to evaluate the impact of early platelet transfusion on 24-h all-cause mortality and 2/ to describe platelet count at admission (PCA) and its relationship with trauma severity and outcome. Methods Observational study carried out on a multicentre prospective trauma registry. All adult trauma patients directly admitted in participating trauma centres between May 2011 and June 2019 were included. Severe haemorrhage was defined as ≥ 4 red blood cell units within 6 h and/or death from exsanguination. The impact of PCA and early platelet transfusion (i.e. within the first 6 h) on 24-h all-cause mortality was assessed using uni- and multivariate logistic regression. Results Among the 19,596 included patients, PCA (229 G/L [189,271]) was associated with coagulopathy, traumatic...
lyophilized plasma versus fresh frozen plasma for the initial management of trauma-induced coagul... more lyophilized plasma versus fresh frozen plasma for the initial management of trauma-induced coagulopathy: a randomized open-label trial.
Résultats. -Cinq cent quarante-deux patients ont été inclus. L'âge moyen était de 42 AE 20 ans, l... more Résultats. -Cinq cent quarante-deux patients ont été inclus. L'âge moyen était de 42 AE 20 ans, le ratio H/F de 4/1. La répartition des GCS était 26 % de GCS 3, 23 % de GCS 4-5 et 46 % de GCS 6-8. Les polytraumatisés étaient 60 % (n = 401) dont 15 % en état de choc (n = 79). Au moins un mydriase aréactive a été retrouvée chez 25 % des patients (n = 137) et 58 % d'entre eux (n = 80) ont bénéficié d'une osmothérapie. Pendant les 48 premières heures, 24 % des patients ont eu un épisode d'hypotension, 26 % un épisode d'hypoxémie et 5 % une anémie. Les délais d'arrivée à l'hôpital étaient de 114 AE 38 minutes et 77 % des patients ont été hospitalisés dans un centre traumatologique spécialisé. Un bloc neurochirurgical urgent a été nécessaire chez 12 % des TCG. La mortalité observée à 48 heures était de 28 % (n = 148). En analyse multivariée, le risque de décès est lié à l'âge, à l'anémie (risque  3), à l'hypotension artérielle (risque  10) et à l'absence d'osmothérapie pendant une mydriase aréactive (risque  18). Conclusion. -Le contrôle de la pression artérielle, le
... Unité de réanimation chirurgicale CHU Bicêtre, Le Kremlin-Bicêtre ; Pr Bruno Riou, Dr Daniell... more ... Unité de réanimation chirurgicale CHU Bicêtre, Le Kremlin-Bicêtre ; Pr Bruno Riou, Dr Danielle Sartorius, Dr Yan Zhao, Service d'accueil des urgences, Pr Olivier Langeron, Dr Frédéric Marmion, Dr ... Riou B, Carli P, Thicoïpé M, Atain-Kouadio P (2003) Comment évaluer la gravité ...
127 F-AM White matter lesions localisation and clinical outcome in severe traumatic brain injury:... more 127 F-AM White matter lesions localisation and clinical outcome in severe traumatic brain injury: a DTI study,
A better understanding of the natural history of intracerebral haemorrhages (ICH) with cohorts re... more A better understanding of the natural history of intracerebral haemorrhages (ICH) with cohorts representing the whole spectrum of the disease is necessary to improve treatment. Our aim was to identify potential differences in baseline characteristics and short-term outcomes of patients with non-traumatic ICH, included in a hospital- and in a population-based stroke registry. We compared 373 patients recruited in a university hospital and the last 373 ICH patients included in a population-based registry. Both cohorts included consecutive patients with non-traumatic parenchymal haemorrhages. In the hospital cohort, we collected data from all patients admitted in the emergency room, irrespective of the clinical severity and of the specialist in charge of the patient.In the hospital cohort, patients were younger and more often alcoholic, but these differences may be explained by the younger age and a higher prevalence of alcoholism in this area. Patients also had more frequently hypercholesterolemia, and were more often under antiplatelet therapy. Both cohorts did not differ for intra-hospital casefatality rate.The characteristics of patients included in the hospital cohort were very close to those of patients from a population-based registry, and the differences observed are likely to be explained by differences in the characteristics of the populations in the two areas and different periods of recruitment. Recruiting patients in emergency rooms, and not in stroke units, neurological, or neurosurgical departments, has enabled us to build a cohort of ICH patients representative of the whole spectrum of the disease, with minimised recruitment bias and maximised precision of the variables collected. This cohort may, therefore, provide reliable information on the natural history of ICH.
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