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Now showing items 1 - 11 of 11

  • Sedation Interruption for Mechanically Ventilated Patients

    Brun-Buisson, Christian   Schortgen, Frederique  

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  • Les DSMB : 1. Quel rôle, quelles responsabilités ?

    Brun-Buisson, Christian  

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  • Early Corticosteroids in Severe Influenza A/H1N1 Pneumonia and Acute Respiratory Distress Syndrome

    Brun-Buisson, Christian   Richard, Jean-Christophe M.   Mercat, Alain   Thiébaut, Anne C. M.   Brochard, Laurent  

    Rationale: Despite their controversial role, corticosteroids are often administered to patients with adult respiratory distress syndrome (ARDS) secondary to viral pneumonia. Objectives: To analyze the impact of corticosteroid therapy on outcomes of patients having ARDS associated with influenza A/H1N1 pneumonia. Methods: Patients from the French registry of critically ill patients with influenza A/H1N1v 2009 infection were selected if fulfilling criteria for ARDS, excluding patients having other indication for corticosteroids, or decompensated underlying disease as the primary cause for intensive care unit admission. Survival to hospital discharge was analyzed using Cox regression, accounting for the time to administration of steroids, and after adjustment on the propensity for receiving steroid therapy. Measurements and Main Results: Of 208 patients with ARDS, 83 (39.9%) received corticosteroids (median initial dose of 270 mg equivalent hydrocortisone per day for a median of 11 d). Steroid therapy was associated with death, both in crude analysis (33.7 vs. 16.8%; hazard ratio, 2.4; 95% CI, 1.3-4.3; P = 0.004) and after propensity score-adjusted analysis (adjusted hazard ratio, 2.82; 95% CI, 1.5-5.4; P = 0.002), controlling for an admission severity Simplified Acute Physiology Score, version 3, greater than 50, initial administration of vasopressors, and immunodepression. Early therapy (<= 3 d of mechanical ventilation) appeared more strongly associated with mortality than late administration. Patients receiving steroids had more acquired pneumonia and a trend to a longer duration of ventilation. Conclusions: Our study provides no evidence of a beneficial effect of corticosteroids in patients with ARDS secondary to influenza pneumonia, but suggests that very early corticosteroid therapy may be harmful.
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  • Les DSMB 2. De l’importance d’un DSMB efficace : exemples d’essais cliniques « à risque »

    Brun-Buisson, Christian  

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  • Administration of Antibiotics for Pneumonia during Respiratory Failure: Reaching the Target

    Brun-Buisson, Christian   Lemaire, Fran?ois  

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  • Corticosteroid Therapy in Acute Respiratory Distress Syndrome

    Brun-Buisson, Christian   Brochard, Laurent  

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  • Contribution of Blinded, Protected Quantitative Specimens to the Diagnostic and Therapeutic Management of Ventilator-Associated Pneumonia

    Brun-Buisson, Christian   Fartoukh, Muriel   Lechapt, Emmanuelle   Honoré, Stéphanie   Zahar, Jean-Ralph   Cerf, Charles   Maitre, Bernard  

    Objective: Sampling techniques for microbiological diagnosis of ventilator-associated pneumonia NAP) remain debated, and it is unclear to what extent invasive diagnostic techniques impact the management of patients. Design: A prospective observational study of 68 first episodes of suspected pneumonia in which specimens were obtained blindly (endotracheal aspirate [EA] and blinded protected telescoping catheter [PTC]) and via bronchoscopy (directed PTC bronchoscopy and BAL), and in sequence, and the results were provided to the attending physicians in the same order. Therapeutic plans resulting at each step were examined, and their adequacy was assessed using quantitative BAL fluid culture as the diagnostic standard. Participants: Sixty-eight patients with clinically suspected VAP hospitalized in two ICUs in a tertiary care university hospital. Results: There were 35 patients (51%) with VAP confirmed by BAIL fluid culture (13 early onset and 22 late onset). EA specimens grew organisms (light growth or more) in all BAL-confirmed VAP cases and 59% of nonconfirmed cases, whereas the sensitivity and specificity of blinded PTC quantitative cultures were 77% and 97%, and did not differ from those of directed PTC cultures (77% and 94%, respectively). Antibiotic therapy based on the clinical severity and likelihood of VAP, Gram stain results, and early blinded PTC culture results was adequate in 54% (19 of 35 VAP patients) within 2 h of sampling and 80% (28 of 35 patients) within 24 h; therapy was revised in only 3 more patients following BAL culture results. New antibiotics were introduced within the first 24 h in 14 of 33 nonconfirmed episodes (42%), and antibiotics were withheld or withdrawn within 48 h in 23 episodes (70%); three of these patients-with both blinded PTC and BAL growing organisms below the threshold- had early subsequently confirmed pneumonia with the same organism. Conclusions: A therapeutic approach guided by quantitative cultures of blinded specimens helps achieve early adequate management of approximately 90% of patients suspected of having VAP.
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  • A Payer Perspective of the Hospital Inpatient Additional Care Costs of Antimicrobial Resistance in France: A Matched Case–Control Study

    Touat, Mehdi   Opatowski, Marion   Brun-Buisson, Christian   Cosker, Kristel   Guillemot, Didier   Salomon, Jerome   Tuppin, Philippe   de Lagasnerie, Gregoire   Watier, Laurence  

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  • Peut-on mettre en pratique les recommandations et comment?D\"aprés la communication de Christian Brun-Buisson


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    Brun-Buisson, Christian   Philippon, Alain   Ansquer, Muriel   Legrand, Patrick   Montravers, Francoise   Duval, Jean  

    Klebsiella pneumoniae strains that were resistant to third-generation cephalosporins and amikacin were recovered from 62 of 395 patients (15.7%) during 1986. 25 isolates (40%) caused urinary tract infections. The outbreak involved three intensive care units (54 isolates), and spread from one unit to another and then to four wards (8 isolates). K pneumoniae of various serotypes and strains of different Enterobacteriaceae demonstrating the same antibiotic resistance pattern were isolated, which suggests dissemination of an R-factor. The isolates had low-level resistance to third-generation cephalosporins (mode minimum inhibitory concentration of cefotaxime, 2 mg/l) but remained sensitive to cephamycins. Cefotaxime was effective in cases of uncomplicated urinary tract infection, but failed in major infections at other sites. 1-5 mg/l of the beta-lactamase inhibitors clavulanic acid or sulbactam restored normal activity to cefotaxime against the multiresistant strains. Resistance to third-generation cephalosporins was mediated by a new broad-spectrum enzyme of isoelectric point 6.3. Resistance to beta-lactams and aminoglycosides was transferable to Escherichia coli. The emergence of transferable enzymatic resistance to newer beta-lactams in K pneumoniae strains indicates a major risk of spread of such resistance to otherwise sensitive strains.
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  • Intestinal decontamination for control of nosocomial multiresistant gram-negative bacilli. Study of an outbreak in an intensive care unit: Brun-Buisson C, Legrand P, Rauss A, et al. Ann Intern Med 1989;110:873-81. Reprint requests: Christian Brun-Buisson, MD, Service de Reanimation Medicale, Ho?pital Henri Mondor, 94010 Creteil, France

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