Biblio du mois : Janvier 2019
Ouverture de la biblio du mois version 2019 !
On démarre avec la belle étude sur les hacks d’articles by sci-hub !
Beaucoup de belles revues, de quoi vous alimenter pendant ces mois d’hiver.
De l’infectio, de la physio appliquée en Anesthésie et en Réanimation ! De grosses études sur le relais per os précoce pour les endocardites et les infections ostéo-articulaires : Gestion péri-opératoire incluse 😉
Du nouveau avec de l’hormonologie au regard de nouvaux biomarqueurs potentiels très physiologiques : Adrénomodulline, Rénine, etc.
En bonus, ce mois-ci, une étude sur la mortalité des personnages de Game of Thrones… et une autre qui montre les effets de la déprivation de sommeil chez les médecins…
On vous rappelle que pour en profiter au maximum, on vous a fait un tuto : ici
Utilisation de Sci-Hub dans le Monde
Till et al., Lancet, 2019
Revue sur le SDRA pédiatrique
Relai per os :
Pour les endocardites :
Iversen et al., NEJM, 2019
Patients with infective endocarditis on the left side of the heart are typically treated with intravenous antibiotic agents for up to 6 weeks. Whether a shift from intravenous to oral antibiotics once the patient is in stable condition would result in efficacy and safety similar to those with continued intravenous treatment is unknown.
In a randomized, noninferiority, multicenter trial, we assigned 400 adults in stable condition who had endocarditis on the left side of the heart caused by streptococcus, Enterococcus faecalis, Staphylococcus aureus, or coagulase-negative staphylococci and who were being treated with intravenous antibiotics to continue intravenous treatment (199 patients) or to switch to oral antibiotic treatment (201 patients). In all patients, antibiotic treatment was administered intravenously for at least 10 days. If feasible, patients in the orally treated group were discharged to outpatient treatment. The primary outcome was a composite of all-cause mortality, unplanned cardiac surgery, embolic events, or relapse of bacteremia with the primary pathogen, from the time of randomization until 6 months after antibiotic treatment was completed.
After randomization, antibiotic treatment was completed after a median of 19 days (interquartile range, 14 to 25) in the intravenously treated group and 17 days (interquartile range, 14 to 25) in the orally treated group (P=0.48). The primary composite outcome occurred in 24 patients (12.1%) in the intravenously treated group and in 18 (9.0%) in the orally treated group (between-group difference, 3.1 percentage points; 95% confidence interval, −3.4 to 9.6; P=0.40), which met noninferiority criteria.
In patients with endocarditis on the left side of the heart who were in stable condition, changing to oral antibiotic treatment was noninferior to continued intravenous antibiotic treatment.
Pour les infections ostéo-articulaires :
Li et al., NEJM, 2019
The management of complex orthopedic infections usually includes a prolonged course of intravenous antibiotic agents. We investigated whether oral antibiotic therapy is noninferior to intravenous antibiotic therapy for this indication.
We enrolled adults who were being treated for bone or joint infection at 26 U.K. centers. Within 7 days after surgery (or, if the infection was being managed without surgery, within 7 days after the start of antibiotic treatment), participants were randomly assigned to receive either intravenous or oral antibiotics to complete the first 6 weeks of therapy. Follow-on oral antibiotics were permitted in both groups. The primary end point was definitive treatment failure within 1 year after randomization. In the analysis of the risk of the primary end point, the noninferiority margin was 7.5 percentage points.
Among the 1054 participants (527 in each group), end-point data were available for 1015 (96.3%). Treatment failure occurred in 74 of 506 participants (14.6%) in the intravenous group and 67 of 509 participants (13.2%) in the oral group. Missing end-point data (39 participants, 3.7%) were imputed. The intention-to-treat analysis showed a difference in the risk of definitive treatment failure (oral group vs. intravenous group) of −1.4 percentage points (90% confidence interval [CI], −4.9 to 2.2; 95% CI, −5.6 to 2.9), indicating noninferiority. Complete-case, per-protocol, and sensitivity analyses supported this result. The between-group difference in the incidence of serious adverse events was not significant (146 of 527 participants [27.7%] in the intravenous group and 138 of 527 [26.2%] in the oral group; P=0.58). Catheter complications, analyzed as a secondary end point, were more common in the intravenous group (9.4% vs. 1.0%).
Oral antibiotic therapy was noninferior to intravenous antibiotic therapy when used during the first 6 weeks for complex orthopedic infection, as assessed by treatment failure at 1 year.
Etude randomisée e-cig vs subtituts nicotiniques
Hajek et al., NEJM, 2019
Revue sur le choc hémorragique
Cannon et al., NEJM, 2019
Revue sur la tolérance aux opioïdes
J.A. Jeevendra Martyn, et al., NEJM, 2019
Haldol pour raccourcir le Délirium en Réanimation ?
Girard et al., NEJM, 2018
There are conflicting data on the effects of antipsychotic medications on delirium in patients in the intensive care unit (ICU).
In a randomized, double-blind, placebo-controlled trial, we assigned patients with acute respiratory failure or shock and hypoactive or hyperactive delirium to receive intravenous boluses of haloperidol (maximum dose, 20 mg daily), ziprasidone (maximum dose, 40 mg daily), or placebo. The volume and dose of a trial drug or placebo was halved or doubled at 12-hour intervals on the basis of the presence or absence of delirium, as detected with the use of the Confusion Assessment Method for the ICU, and of side effects of the intervention. The primary end point was the number of days alive without delirium or coma during the 14-day intervention period. Secondary end points included 30-day and 90-day survival, time to freedom from mechanical ventilation, and time to ICU and hospital discharge. Safety end points included extrapyramidal symptoms and excessive sedation.
Written informed consent was obtained from 1183 patients or their authorized representatives. Delirium developed in 566 patients (48%), of whom 89% had hypoactive delirium and 11% had hyperactive delirium. Of the 566 patients, 184 were randomly assigned to receive placebo, 192 to receive haloperidol, and 190 to receive ziprasidone. The median duration of exposure to a trial drug or placebo was 4 days (interquartile range, 3 to 7). The median number of days alive without delirium or coma was 8.5 (95% confidence interval [CI], 5.6 to 9.9) in the placebo group, 7.9 (95% CI, 4.4 to 9.6) in the haloperidol group, and 8.7 (95% CI, 5.9 to 10.0) in the ziprasidone group (P=0.26 for overall effect across trial groups). The use of haloperidol or ziprasidone, as compared with placebo, had no significant effect on the primary end point (odds ratios, 0.88 [95% CI, 0.64 to 1.21] and 1.04 [95% CI, 0.73 to 1.48], respectively). There were no significant between-group differences with respect to the secondary end points or the frequency of extrapyramidal symptoms.
The use of haloperidol or ziprasidone, as compared with placebo, in patients with acute respiratory failure or shock and hypoactive or hyperactive delirium in the ICU did not significantly alter the duration of delirium.
Brève revue sur les antipsychotiques contre le Delirium en Réanimation : NS ?
Castellanos et al., NEJM, 2019
Effet de la kétamine intra-nasale sur les douleurs chez l’enfant ?
Frey TM, Florin TA, Caruso M, et al.
Effect of Intranasal Ketamine vs Fentanyl on Pain Reduction for Extremity Injuries in Children: The PRIME Randomized Clinical Trial.
JAMA Pediatr. 2018 Dec 28. pii: 2718506.
Revue sur la prise en charge des allergies aux Pénicillines
Revue sur les méta-analyses à effets aléatoires
Différences de traitement entre BPCO et Asthme
Maselli et al., Chest, 2019
Méta-analyse sur le syndrome d’Apnées du Sommeil et difficulté d’intubation
Revue sur l’IRA associée au sepsis
Poston & Koyner, BMJ 2019; 364
Interactions hôte-pathogène dans les infections graves à Pneumocoque
Bedos et al., ICM, 2018
To assess the relative importance of host and bacterial factors associated with hospital mortality in patients admitted to the intensive care unit (ICU) for pneumococcal community-acquired pneumonia (PCAP).
Immunocompetent Caucasian ICU patients with PCAP documented by cultures and/or pneumococcal urinary antigen (UAg Sp) test were included in this multicenter prospective study between 2008 and 2012. All pneumococcal strains were serotyped. Logistic regression analyses were performed to identify risk factors for hospital mortality.
Of the 614 patients, 278 (45%) had septic shock, 270 (44%) had bacteremia, 307 (50%) required mechanical ventilation at admission, and 161 (26%) had a diagnosis based only on the UAg Sp test. No strains were penicillin-resistant, but 23% had decreased susceptibility. Of the 36 serotypes identified, 7 accounted for 72% of the isolates, with different distributions according to age. Although antibiotics were consistently appropriate and were started within 6 h after admission in 454 (74%) patients, 116 (18.9%) patients died. Independent predictors of hospital mortality in the adjusted analysis were platelets ≤ 100 × 109/L (OR, 7.7; 95% CI, 2.8–21.1), McCabe score ≥ 2 (4.58; 1.61–13), age > 65 years (2.92; 1.49–5.74), lactates > 4 mmol/L (2.41; 1.27–4.56), male gender and septic shock (2.23; 1.30–3.83 for each), invasive mechanical ventilation (1.78; 1–3.19), and bilateral pneumonia (1.59; 1.02–2.47). Women with platelets ≤ 100 × 109/L had the highest mortality risk (adjusted OR, 7.7; 2.8–21).
In critically ill patients with PCAP, age, gender, and organ failures at ICU admission were more strongly associated with hospital mortality than were comorbidities. Neither pneumococcal serotype nor antibiotic regimen was associated with hospital mortality.
Perfusions prolongées d’ATB chez les neutropéniques ?
Ram et al., CID, 2018
Febrile neutropenia may be a sign of severe infection and is associated with significant morbidity and mortality in high-risk patients with hematologic malignancies. Extended infusion of β-lactam antibiotics is associated with greater clinical response than is bolus infusion in nonneutropenic critically ill patients, but data are lacking for febrile neutropenic patients.
We designed a single-center, nonblinded, randomized trial to compare extended infusion (4 hours) and bolus infusion (30 minutes) of piperacillin-tazobactam or ceftazidime in high-risk patients with febrile neutropenia. The primary endpoint was overall response on day 4, defined as the combination of resolution of fever, sterile blood cultures, resolution of clinical signs and symptoms, and no need for a change in the antibiotic regimen. Outcome was adjudicated by investigators blinded to treatment allocation.
Of 123 enrolled patients, 105 had febrile neutropenia and were included in the intention-to-treat analysis: 47 in the extended infusion arm and 58 in the bolus infusion arm. Overall response occurred in 35 (74.4%) patients treated with extended infusion and 32 (55.1%) patients treated with bolus infusion (P = .044). The superiority of extended infusion was greatest for patients with clinically documented infections (overall response, 68.4% [13/19] vs 35.7% [10/28]; P = .039) and specifically for those with pneumonia (80% [4/5] vs 0% [0/8]; P = .007).
Extended infusion of β-lactams is associated with superior treatment outcomes compared with bolus infusion for high-risk patients with febrile neutropenia. The benefit of extended β-lactam infusion may be greatest for patients with pulmonary infections.
Recommandations sur l’antibiothérapie extra-hospitalière
Epidémiologie du syndrome du compartiment abdominal
Objectives: To identify the prevalence, risk factors, and outcomes of intra-abdominal hypertension in a mixed multicenter ICU population.
Design: Prospective observational study.
Setting: Fifteen ICUs worldwide.
Patients: Consecutive adult ICU patients with a bladder catheter.
Measurements and Main Results: Four hundred ninety-one patients were included. Intra-abdominal pressure was measured a minimum of every 8 hours. Subjects with a mean intra-abdominal pressure equal to or greater than 12 mm Hg were defined as having intra-abdominal hypertension. Intra-abdominal hypertension was present in 34.0% of the patients on the day of ICU admission (159/467) and in 48.9% of the patients (240/491) during the observation period. The severity of intra-abdominal hypertension was as follows: grade I, 47.5%; grade II, 36.6%; grade III, 11.7%; and grade IV, 4.2%. The severity of intra-abdominal hypertension during the first 2 weeks of the ICU stay was identified as an independent predictor of 28- and 90-day mortality, whereas the presence of intra-abdominal hypertension on the day of ICU admission did not predict mortality. Body mass index, Acute Physiology and Chronic Health Evaluation II score greater than or equal to 18, presence of abdominal distension, absence of bowel sounds, and positive end-expiratory pressure greater than or equal to 7 cm H2O were independently associated with the development of intra-abdominal hypertension at any time during the observation period. In subjects without intra-abdominal hypertension on day 1, body mass index combined with daily positive fluid balance and positive end-expiratory pressure greater than or equal to 7 cm H2O (as documented on the day before intra-abdominal hypertension occurred) were associated with the development of intra-abdominal hypertension during the first week in the ICU.
Conclusions: In our mixed ICU patient cohort, intra-abdominal hypertension occurred in almost half of all subjects and was twice as prevalent in mechanically ventilated patients as in spontaneously breathing patients. Presence and severity of intra-abdominal hypertension during the observation period significantly and independently increased 28- and 90-day mortality. Five admission day variables were independently associated with the presence or development of intra-abdominal hypertension. Positive fluid balance was associated with the development of intra-abdominal hypertension after day 1.
Revue sur l’intérêt du Carnet de Bord en réanimation : Diminue l’Anxiété, la Dépression et Améliore la qualité de vie post-réa ?
Revue sur l’AC/FA de novo liée au sepsis
La rénine comme marqueur d’hypoperfusion tissulaire ?
Objectives: To characterize renin in critically ill patients. Renin is fundamental to circulatory homeostasis and could be a useful marker of tissue-perfusion. However, diurnal variation, continuous renal replacement therapy and drug-interference could confound its use in critical care practice.
Design: Prospective observational study.
Setting: Single-center, mixed medical-surgical ICU in Europe.
Patients: Patients over 18 years old with a baseline estimated glomerular filtration rate greater than 30 mL/min/1.73 m2 and anticipated ICU stay greater than 24 hours. Informed consent was obtained from the patient or next-of-kin.
Interventions: Direct plasma renin was measured in samples drawn 6-hourly from arterial catheters in recumbent patients and from extracorporeal continuous renal replacement therapy circuits. Physiologic variables and use of drugs that act on the renin-angiotensin-aldosterone system were recorded prospectively. Routine lactate measurements were used for comparison.
Measurements and Main Results: One-hundred twelve arterial samples (n = 112) were drawn from 20 patients (65% male; mean ± SD, 60 ± 14 yr old) with septic shock (30%), hemorrhagic shock (15%), cardiogenic shock (20%), or no circulatory shock (35%). The ICU mortality rate was 30%. Renin correlated significantly with urine output (repeated-measures correlation coefficient = –0.29; p = 0.015) and mean arterial blood pressure (repeated-measures correlation coefficient = –0.35; p < 0.001). There was no diurnal variation of renin or significant interaction of renin-angiotensin-aldosterone system drugs with renin in this population. Continuous renal replacement therapy renin removal was negligible (mass clearance ± SD 4% ± 4.3%). There was a significant difference in the rate of change of renin over time between survivors and nonsurvivors (–32 ± 26 μU/timepoint vs +92 ± 57 μU/timepoint p = 0.03; mean ± SEM), but not for lactate (–0.14 ± 0.04 mM/timepoint vs +0.15 ± 0.21 mM/timepoint; p = 0.07). Maximum renin achieved significant prognostic value for ICU mortality (receiver operator curve area under the curve 0.80; p = 0.04), whereas maximum lactate did not (receiver operator curve area under the curve, 0.70; p = 0.17).
Conclusions: In an heterogeneous ICU population, renin measurement was not significantly affected by diurnal variation, continuous renal replacement therapy, or drugs. Renin served as a marker of tissue-perfusion and outperformed lactate as a predictor of ICU mortality.
Revue sur l’anticoagulation au citrate d’EER chez les patients avec une défailance hépatique
Wei Zhang†, et al., Critical Care 2019 23:22
Utilité de l’Adrénomodulline circulante dans le sepsis ?
Mebazaa et al., Critical Care201822:354
Adrenomedullin (ADM) regulates vascular tone and endothelial permeability during sepsis. Levels of circulating biologically active ADM (bio-ADM) show an inverse relationship with blood pressure and a direct relationship with vasopressor requirement. In the present prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock 1 (, AdrenOSS-1) study, we assessed relationships between circulating bio-ADM during the initial intensive care unit (ICU) stay and short-term outcome in order to eventually design a biomarker-guided randomized controlled trial.
AdrenOSS-1 was a prospective observational multinational study. The primary outcome was 28-day mortality. Secondary outcomes included organ failure as defined by Sequential Organ Failure Assessment (SOFA) score, organ support with focus on vasopressor/inotropic use, and need for renal replacement therapy. AdrenOSS-1 included 583 patients admitted to the ICU with sepsis or septic shock.
Circulating bio-ADM levels were measured upon admission and at day 2. Median bio-ADM concentration upon admission was 80.5 pg/ml [IQR 41.5–148.1 pg/ml]. Initial SOFA score was 7 [IQR 5–10], and 28-day mortality was 22%. We found marked associations between bio-ADM upon admission and 28-day mortality (unadjusted standardized HR 2.3 [CI 1.9–2.9]; adjusted HR 1.6 [CI 1.1–2.5]) and between bio-ADM levels and SOFA score (p < 0.0001). Need of vasopressor/inotrope, renal replacement therapy, and positive fluid balance were more prevalent in patients with a bio-ADM > 70 pg/ml upon admission than in those with bio-ADM ≤ 70 pg/ml. In patients with bio-ADM > 70 pg/ml upon admission, decrease in bio-ADM below 70 pg/ml at day 2 was associated with recovery of organ function at day 7 and better 28-day outcome (9.5% mortality). By contrast, persistently elevated bio-ADM at day 2 was associated with prolonged organ dysfunction and high 28-day mortality (38.1% mortality, HR 4.9, 95% CI 2.5–9.8).
AdrenOSS-1 shows that early levels and rapid changes in bio-ADM estimate short-term outcome in sepsis and septic shock. These data are the backbone of the design of the biomarker-guided AdrenOSS-2 trial.
Revue sur les outcomes utilisés dans les études randomisées sur la nutrition en réanimation
Garry Taverny, et al. Critical Care 2019 23:12
Revue sur la gestion des patients sarcopéniques en réanimation
Journal of Critical Care, 2019
Effet de la Nimodipine intra-artérielle pour les vasospasmes cérébraux
Background: Intra-arterial nimodipine (IaN) is used in the management of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). The impact of IaN therapy on regional cerebral oxygen saturation (rScO2) assessed by near infra-red spectroscopy, and dynamic cardiac indices, is currently unknown. This study assessed the effect of IaN on rScO2 and systemic hemodynamic indices during IaN therapy for cerebral vasospasm after aSAH.
Methods: This prospective cohort study was conducted in 20 patients over sixteen month period after ethics committee approval and informed consent. Patients with angiographic evidence of vasospasm received IaN 3mg over 30 minutes in the spastic vessels. Data regarding rScO2 heart rate (HR), mean blood pressure (MBP) cardiac index (CI), stroke volume index (SVI), stroke volume variation (SVV), and total peripheral resistance index (TPRI) were collected during IaN treatment. The primary outcome measure was change in rScO2 after IaN therapy.
Results: There was no significant change from baseline in ipsilateral and contralateral rScO2 after IaN administration (mean difference [MD], 0.2; 95% confidence interval [CI], −2.1 to 1.6; P=0.804, and 1.3; −1.1 to 3.8; P=0.276, respectively). There was a significant decrease in MBP and TPRI (MD, −12.4; 95% CI, −6.6 to −18.2; P<0.001, and −674.3; −374.9 to −973.7; P<0.001, respectively) and increase in SVI and CI (MD, 7.5; 95% CI, 14.4 to 0.6; P=0.035 and 0.7; 0.9 to 0.4; P<0.001, respectively) after IaN therapy. HR and SVV were unchanged.
Conclusions: IaN for aSAH-related cerebral vasospasm did not improve rScO2 but was associated with significant systemic hemodynamic effects, including a decrease in MBP and TPRI. These hemodynamic changes might offset any potential effects of IaN to improve rScO2.
Conséquences du manque de sommeil post garde chez les médecins ?
On endommage notre ADN ???
Cheung et al., Anesthesia, 2019
Transplantation pulmonaire pour
les défaillances cardiaques droites sur HTAP pré-capillaire ?
Lorsque les cliniciens ont un objectif de traitement clair, comme la transplantation ou la récupération, chez les patients atteints d’hypertension artérielle pulmonaire (HTAP), un traitement de pointe aux soins intensifs et une aide à la survie extracorporelle (ECLS) sont nécessaires; Cependant, selon un article publié dans le European Respiratory Journal, les soins intensifs avancés peuvent être vains lorsque ces objectifs de traitement ne sont pas réalistes et que les meilleurs soins de soutien deviennent le meilleur choix.
Bien que des progrès thérapeutiques aient été accomplis, l’HTAP demeure une maladie chronique incurable et souvent fatale. Les soins intensifs de ces patients sont axés sur la gestion prudente des liquides, la gestion des facteurs pouvant causer l’insuffisance cardiaque ou y contribuer, ainsi que des stratégies pour améliorer la fonction cardiaque et réduire la postcharge ventriculaire. Dans des situations distinctes avec des objectifs de traitement clairs, comme chez les candidats à la transplantation pulmonaire, l’oxygénation extracorporelle par membrane (ECMO) doit être envisagée. Cependant, l’ECMO n’est pas une bonne option dans les cas d’insuffisance d’organes terminale lorsque les patients n’ont aucune chance réaliste de subir une transplantation ou de récupérer.
La transplantation pulmonaire reste une option de traitement importante pour les patients atteints d’une maladie réfractaire. Les patients qui ont reçu un traitement optimisé contre l’HTAP, mais qui appartiennent à une catégorie à risque élevé ou intermédiaire, devraient être envisagés pour une greffe. Il est possible de prévenir le dysfonctionnement primaire du greffon en prolongeant l’ECMO veino-artériel postopératoire après une greffe. Dans les centres expérimentés dans ces techniques, le taux de survie à un an est maintenant supérieur à 90%.
Les chercheurs ont conclu que l’HTAP demeurera une maladie chronique, incurable et évolutive dans un avenir prévisible. Ils ont noté que « le remodelage inverse de la vasculopathie pulmonaire est une cible principale des recherches en cours, mais que le succès de la maladie humaine a été limité… de futures études devraient viser à développer de nouveaux médicaments pour combattre la maladie elle-même, mais aussi à développer de nouveaux moyens Le développement de l’ECMO (éveillé) comme passerelle vers la transplantation est une première étape… Pour le moment, la transplantation pulmonaire reste une option de traitement importante pour les patients atteints d’HTAP autrement réfractaire. »
Effet de l’ALR et le volume d’anesthésique sur la fonction diaphragmatique ?
Bao X, Huang J, Feng H, et al.
Effect of local anesthetic volume (20 mL vs 30 mL ropivacaine) on electromyography of the diaphragm and pulmonary function after ultrasound-guided supraclavicular brachial plexus block: a randomized controlled trial.
Reg Anesth Pain Med. 2019 Jan;44(1):69-75.
Revue sur la prise en charge des Transplantés pulmonaires en Réanimation
Dexaméthasone pré-opératoire pour prévenir les douleurs liées à l’intubation ?
Kuriyama A, Maeda H. Can J Anaesth. 2019
Preoperative intravenous dexamethasone prevents tracheal intubation-related sore throat in adult surgical patients: a systematic review and meta-analysis.
Revue des recommandations sur la gestion d’acido-cétose
Revue sur les complications liées à la chirurgie bariatrique
Etude de la mortalité chez les personnages de Game of Thrones
Lystad and BrownInjury Epidemiology (2018) 5:44
Revue sur l’intérêt du surfactant dans le SDRA