Physiological and clinical effects of two ultraprotective ventilation strategies in patients with veno-venous extracorporeal membrane oxygenation: the ECMOVENT study.

Purpose: The optimal ventilation strategy in acute respiratory distress syndrome (ARDS) patients with veno-venous extracorporeal membrane oxygenation (VV-ECMO) remains unknown. We aimed to compare the effects of two ultra-protective ventilatory strategies applied to patients with ARDS and VV-ECMO.

Methods: Our study was an observational, retrospective, single-center study with a before-and-after design.

Recovery of Fatigue, Cardiorespiratory Fitness, and Neuromuscular Function in Covid-19 ICU Patients: A 6-Month Follow-Up Study.

Purpose: Although most patients recover well from Covid-19 infection, this may not be the case of those who experienced severe dysfunction after being admitted to intensive care unit (ICU). This study aimed to assess the recovery of patients who experienced severe multiple dysfunctions after being admitted to intensive care unit (ICU) for Covid-19 infection.

Methods: Forty-seven patients hospitalized and mechanically ventilated in ICU for SARS-CoV-2 infection underwent evaluations at 4-8 weeks (T1) and 6 months (T2) post ICU discharge.

Diagnostic performance of the recruitment-to-inflation ratio to assess lung recruitability by PEEP in ARDS. a computed tomography study.

Background: The recruitment-to-inflation (R/I) ratio is a new bedside tool with potential to evaluate lung recruitability by positive end-expiratory pressure (PEEP) but was only validated using pressure-volume curves and the optimal threshold separating low and high recruiters by PEEP is not precisely known. The aim of the study is to evaluate the diagnostic performance of the R/I ratio using computed tomography (CT) as a gold standard in patients with acute respiratory distress syndrome (ARDS).

Methods: This study is a single-center prospective observational study performed on adults ARDS patients under invasive mechanical ventilation.

Chloride Mass Transfers during Continuous Veno-Venous Hemodialysis with Regional Citrate Anticoagulation: Effects of Additional Ultrafiltration and Hamburger's Effect.

Introduction: Dialysate-to-patient chloride mass transfer may occur during continuous veno-venous hemodialysis (CVVHD) with regional citrate anticoagulation (RCA). However, additional RCA-related ultrafiltration (UF) and plasma chloride shifts to the intracellular compartment may impact mass transfer evaluation to an unknown extent.

Methods: In an ancillary prospective, single-center study, we evaluated chloride mass transfer J of adult patients treated with CVVHD-RCA.

Prognostic value of functional CT imaging in COVID-ARDS: a two-centre prospective observational study.

Background: Patients with ARDS have heterogeneous lungs which exposes them to the risk of lung injury exacerbation by mechanical ventilation. Functional lung CT imaging gives a comprehensive description of regional lung mechanical behaviour. Here, we investigated whether CT registration-based regional lung function parameters are associated with survival in patients with COVID-ARDS.

Visual coronary artery calcification score to predict significant coronary artery stenosis in patients presenting with cardiac arrest without ST-segment elevation myocardial infarction.

Background: Emergency coronary angiogram after a cardiac arrest without ST-segment elevation myocardial infarction (STEMI) is still a matter of debate. To better select patients who may benefit from this procedure, we tested a visual coronary artery calcification (VCAC) score available in chest CT to predict significant coronary artery stenosis and/or culprit lesion or ad hoc or delayed percutaneous coronary intervention (PCI).

Results: A total of 113 patients with cardiac arrest and without STEMI who had a coronary angiogram and chest CT (January 2013 to March 2023, Croix-Rousse Hospital, Lyon, France) were retrospectively included.

Fluid balance neutralization secured by hemodynamic monitoring versus protocolized standard of care in patients with acute circulatory failure requiring continuous renal replacement therapy: results of the GO NEUTRAL randomized controlled trial.

Purpose: Net ultrafiltration (UF) during continuous renal replacement therapy (CRRT) can control fluid balance (FB), but is usually 0 ml·h in patients with vasopressors due to the risk of hemodynamic instability associated with CRRT (HIRRT). We evaluated a UF strategy adjusted by functional hemodynamics to control the FB of patients with vasopressors, compared to the standard of care.

Methods: In this randomized, controlled, open-label, parallel-group, multicenter, proof-of-concept trial, adults receiving vasopressors, CRRT since ≤ 24 h and cardiac output monitoring were randomized (ratio 1:1) to receive during 72 h a UF ≥ 100 ml·h, adjusted using a functional hemodynamic protocol (intervention), or a UF ≤ 25 ml·h (control).

Bias, trending ability and diagnostic performance of a non-calibrated multi-beat analysis continuous cardiac output monitor to identify fluid responsiveness in critically ill patients.

Objective: To evaluate the accuracy of non-calibrated multi-beat analysis continuous cardiac output (CCO), against calibrated pulse-contour analysis continuous cardiac output (CCO) during a passive leg raise (PLR) and/or a fluid challenge (FC).

Design: Observational, single-centre, prospective study.

Setting: Tertiary academic medical intensive care unit, Lyon, France.

Spontaneous breathing trial with pressure support on positive end-expiratory pressure and extensive use of non-invasive ventilation versus T-piece in difficult-to-wean patients from mechanical ventilation: a randomized controlled trial.

Background: The aim of this study is to assess whether a strategy combining spontaneous breathing trial (SBT) with both pressure support (PS) and positive end-expiratory pressure (PEEP) and extended use of post-extubation non-invasive ventilation (NIV) (extensively-assisted weaning) would shorten the time until successful extubation as compared with SBT with T-piece (TP) and post-extubation NIV performed in selected patients as advocated by guidelines (standard weaning), in difficult-to-wean patients from mechanical ventilation.

Methods: The study is a single-center prospective open label, randomized controlled superiority trial with two parallel groups and balanced randomization with a 1:1 ratio. Eligible patients were intubated patients mechanically ventilated for more than 24 h who failed their first SBT using TP.

Determinants of Urine Output Using Advanced Hemodynamic Monitoring in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy.

Introduction: Low cardiac output and hypovolemia are candidate macrocirculatory mechanisms explanatory of de novo anuria in intensive care unit (ICU) patients undergoing continuous renal replacement therapy (CRRT). We aimed to determine the hemodynamic parameters and CRRT settings associated with the longitudinal course of UO during CRRT.

Methods: This is an ancillary analysis of the PRELOAD CRRT observational, single-center study (NCT03139123).

Virological and clinical features of acute respiratory failure associated with COVID-19 in pregnancy: a case-control study.

Pregnancy is a risk factor for acute respiratory failure (ARF) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We hypothesised that SARS-CoV-2 viral load in the respiratory tract might be higher in pregnant intensive care unit (ICU) patients with ARF than in non-pregnant ICU patients with ARF as a consequence of immunological adaptation during pregnancy. Single-centre, retrospective observational case-control study.

Safety of inter-facility transport strategies for patients referred for severe acute respiratory distress syndrome.

Background: Inter-facility transport of patients with acute respiratory distress syndrome (ARDS) in the prone position (PP) is a high-risk situation, compared to other strategies. We aimed to quantify the prevalence of complications during transport in PP, compared to transports with veno-venous extracorporeal membrane oxygenation (VV-ECMO) or in the supine position (SP).

Methods: We performed a retrospective, single center cohort study in Lyon university hospital, France.

Ultra-low tidal volume ventilation for COVID-19-related ARDS in France (VT4COVID): a multicentre, open-label, parallel-group, randomised trial.

Background: COVID-19-related acute respiratory distress syndrome (ARDS) is associated with a high mortality rate and longer mechanical ventilation. We aimed to assess the effectiveness of ventilation with ultra-low tidal volume (ULTV) compared with low tidal volume (LTV) in patients with COVID-19-related ARDS.

Methods: This study was a multicentre, open-label, parallel-group, randomised trial conducted in ten intensive care units in France.

Precision of CT-derived alveolar recruitment assessed by human observers and a machine learning algorithm in moderate and severe ARDS.

Background: Assessing measurement error in alveolar recruitment on computed tomography (CT) is of paramount importance to select a reliable threshold identifying patients with high potential for alveolar recruitment and to rationalize positive end-expiratory pressure (PEEP) setting in acute respiratory distress syndrome (ARDS). The aim of this study was to assess both intra- and inter-observer smallest real difference (SRD) exceeding measurement error of recruitment using both human and machine learning-made lung segmentation (i.e.

Respiratory multiplex PCR and procalcitonin to reduce antibiotic exposure in severe SARS-CoV-2 pneumonia: a multicentre randomized controlled trial.

Objectives: We aimed at assessing the efficacy and safety on antibiotic exposure of a strategy combining a respiratory multiplex PCR (mPCR) with enlarged panel and daily procalcitonin (PCT) measurements, as compared with a conventional strategy, in adult patients who were critically ill with laboratory-confirmed SARS-CoV-2 pneumonia.

Methods: This multicentre, parallel-group, open-label, randomized controlled trial enrolled patients admitted to 13 intensive care units (ICUs) in France. Patients were assigned (1:1) to the control strategy, in which antibiotic streamlining remained at the discretion of the physicians, or interventional strategy, consisting of using mPCR and daily PCT measurements within the first 7 days of randomization to streamline initial antibiotic therapy, with antibiotic continuation encouraged when PCT was >1 ng/mL and discouraged if < 1 ng/mL or decreased by 80% from baseline.