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  • Online Resource  (4)
  • Ovid Technologies (Wolters Kluwer Health)  (4)
  • Terzi, Nicolas  (4)
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  • Online Resource  (4)
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  • Ovid Technologies (Wolters Kluwer Health)  (4)
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  • 1
    Online Resource
    Online Resource
    Thyroid Storm in the ICU: A Retrospective Multicenter Study
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Critical Care Medicine Vol. 48, No. 1 ( 2020-01), p. 83-90
    Details
    In: Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 1 ( 2020-01), p. 83-90
    Abstract: Thyroid storm represents a rare but life-threatening endocrine emergency. Only rare data are available on its management and the outcome of the most severe forms requiring ICU admission. We aimed to describe the clinical manifestations, management and in-ICU and 6-month survival rates of patients with those most severe thyroid storm forms requiring ICU admission. Design: Retrospective, multicenter, national study over an 18-year period (2000–2017). Setting: Thirty-one French ICUs. Patients: The local medical records of patients from each participating ICU were screened using the International Classification of Diseases , 10th Revision. Inclusion criteria were “definite thyroid storm,” as defined by the Japanese Thyroid Association criteria, and at least one thyroid storm-related organ failure. Measurements and Main Results: Ninety-two patients were included in the study. Amiodarone-associated thyrotoxicosis and Graves’ disease represented the main thyroid storm etiologies (30 [33%] and 24 [26%] patients, respectively), while hyperthyroidism was unknown in 29 patients (32%) before ICU admission. Amiodarone use (24 patients [26%]) and antithyroid-drug discontinuation (13 patients [14%] ) were the main thyroid storm-triggering factors. No triggering factor was identified for 30 patients (33%). Thirty-five patients (38%) developed cardiogenic shock within the first 48 hours after ICU admission. In-ICU and 6-month postadmission mortality rates were 17% and 22%, respectively. ICU nonsurvivors more frequently required vasopressors, extracorporeal membrane of oxygenation, renal replacement therapy, mechanical ventilation, and/or therapeutic plasmapheresis. Multivariable analyses retained Sequential Organ Failure Assessment score without cardiovascular component (odds ratio, 1.22; 95% CI, 1.03–1.46; p = 0.025) and cardiogenic shock within 48 hours post-ICU admission (odds ratio, 9.43; 1.77–50.12; p = 0.008) as being independently associated with in-ICU mortality. Conclusions: Thyroid storm requiring ICU admission causes high in-ICU mortality. Multiple organ failure and early cardiogenic shock seem to markedly impact the prognosis, suggesting a prompt identification and an aggressive management.
    Type of Medium: Online Resource
    ISSN: 0090-3493
    URL: Article
    DOI: 10.1097/CCM.0000000000004078
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2034247-0
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    Online Resource
  • 2
    Online Resource
    Online Resource
    The Clinical Picture of Severe Systemic Capillary-Leak Syndrome Episodes Requiring ICU Admission
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Critical Care Medicine Vol. 45, No. 7 ( 2017-07), p. 1216-1223
    Details
    In: Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 7 ( 2017-07), p. 1216-1223
    Abstract: Systemic capillary-leak syndrome is a very rare cause of recurrent hypovolemic shock. Few data are available on its clinical manifestations, laboratory findings, and outcomes of those patients requiring ICU admission. This study was undertaken to describe the clinical pictures and ICU management of severe systemic capillary-leak syndrome episodes. Design, Setting, Patients: This multicenter retrospective analysis concerned patients entered in the European Clarkson’s disease (EurêClark) Registry and admitted to ICUs between May 1992 and February 2016. Measurements and Main Results: Fifty-nine attacks occurring in 37 patients (male-to-female sex ratio, 1.05; mean ± sd age, 51 ± 11.4 yr) were included. Among 34 patients (91.9%) with monoclonal immunoglobulin G gammopathy, 20 (58.8%) had kappa light chains. ICU-admission hemoglobin and proteinemia were respectively median (interquartile range) 20.2 g/dL (17.9–22 g/dL) and 50 g/L (36.5–58.5 g/L). IV immunoglobulins were infused (IV immunoglobulin) during 15 episodes (25.4%). A compartment syndrome developed during 12 episodes (20.3%). Eleven (18.6%) in-ICU deaths occurred. Bivariable analyses (the 37 patients’ last episodes) retained Sequential Organ-Failure Assessment score greater than 10 (odds ratio, 12.9 [95% CI, 1.2–140]; p = 0.04) and cumulated fluid-therapy volume greater than 10.7 L (odds ratio, 16.8 [1.6–180]; p = 0.02) as independent predictors of hospital mortality. Conclusions: We described the largest cohort of severe systemic capillary-leak syndrome flares requiring ICU admission. High-volume fluid therapy was independently associated with poorer outcomes. IV immunoglobulin use was not associated with improved survival; hence, their use should be considered prudently and needs further evaluation in future studies.
    Type of Medium: Online Resource
    ISSN: 0090-3493
    URL: Article
    DOI: 10.1097/CCM.0000000000002496
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2034247-0
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  • 3
    Online Resource
    Online Resource
    Differential Perceptions of Noninvasive Ventilation in Intensive Care among Medical Caregivers, Patients, and Their Relatives
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Anesthesiology Vol. 124, No. 6 ( 2016-06-01), p. 1347-1359
    Details
    In: Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 124, No. 6 ( 2016-06-01), p. 1347-1359
    Abstract: Noninvasive ventilation (NIV) requires a close “partnership” between a conscious patient and the patient’s caregivers. Specific perceptions of NIV stakeholders and their impact have been poorly described to date. The objectives of this study were to compare the perceptions of NIV by intensive care unit (ICU) physicians, nurses, patients, and their relatives and to explore factors associated with caregivers’ willingness to administer NIV and patients’ and relatives’ anxiety in relation to NIV. Methods This is a prospective, multicenter questionnaire-based study. Results Three hundred and eleven ICU physicians, 752 nurses, 396 patients, and 145 relatives from 32 ICUs answered the questionnaire. Nurses generally reported more negative feelings and more frequent regrets about providing NIV (median score, 3; interquartile range, [1 to 5] vs. 1 [1 to 5] ; P & lt; 0.0001) compared to ICU physicians. Sixty-four percent of ICU physicians and only 32% of nurses reported a high level of willingness to administer NIV, which was independently associated with NIV case-volume and workload. A high NIV session–related level of anxiety was observed in 37% of patients and 45% of relatives. “Dyspnea during NIV,” “long NIV session,” and “the need to have someone at the bedside” were identified as independent risk factors of high anxiety in patients. Conclusions Lack of willingness of caregivers to administer NIV and a high level of anxiety of patients and relatives in relation to NIV are frequent in the ICU. Most factors associated with low willingness to administer NIV by nurses or anxiety in patients and relatives may be amenable to change. Interventional studies are now warranted to evaluate how to reduce these risk factors and therefore contribute to better management of a potentially traumatic experience. (Anesthesiology 2016; 124:1347-59)
    Type of Medium: Online Resource
    ISSN: 0003-3022
    URL: Article
    DOI: 10.1097/ALN.0000000000001124
    RVK:
    XA 22600
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 2016092-6
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  • 4
    Online Resource
    Online Resource
    Pheochromocytoma Crisis in the ICU: A French Multicenter Cohort Study With Emphasis on Rescue Extracorporeal Membrane Oxygenation
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Critical Care Medicine Vol. 45, No. 7 ( 2017-07), p. e657-e665
    Details
    In: Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 7 ( 2017-07), p. e657-e665
    Abstract: To describe the characteristics, management, and outcome of patients admitted to ICUs for pheochromocytoma crisis. Design: A 16-year multicenter retrospective study. Setting: Fifteen university and nonuniversity ICUs in France. Patients: Patients admitted in ICU for pheochromocytoma crisis. Interventions: None. Measurement and Main Results: We included 34 patients with a median age of 46 years (40–54 yr); 65% were males. At admission, the median Sequential Organ Failure Assessment score was 8 (4–12) and median Simplified Acute Physiology Score II 49.5 (27–70). The left ventricular ejection fraction was consistently decreased with a median value of 30% (15–40%). Mechanical ventilation was required in 23 patients, mainly because of congestive heart failure. Vasoactive drugs were used in 23 patients (68%) and renal replacement therapy in eight patients (24%). Extracorporeal membrane oxygenation was used as a rescue therapy in 14 patients (41%). Pheochromocytoma was diagnosed by CT in 33 of 34 patients. When assayed, urinary metanephrine and catecholamine levels were consistently elevated. Five patients underwent urgent surgery, including two during extracorporeal membrane oxygenation. Overall ICU mortality was 24% (8/34), and overall 90-day mortality was 27% (9/34). Crude 90-day mortality was not significantly different between patients managed with versus without extracorporeal membrane oxygenation (22% vs 30%) ( p = 0.7) despite higher severity scores at admission in the extracorporeal membrane oxygenation group. Conclusions: Mortality is high in pheochromocytoma crisis. Routinely considering this diagnosis and performing abdominal CT in patients with unexplained cardiogenic shock may allow an earlier diagnosis. Extracorporeal membrane oxygenation and adrenalectomy should be considered as a therapeutic in most severe cases.
    Type of Medium: Online Resource
    ISSN: 0090-3493
    URL: Article
    DOI: 10.1097/CCM.0000000000002333
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2034247-0
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