Guillaume Debaty

Publications (10) View all

• Source

  Available from: Guillaume Debaty

  Article: Actualités thérapeutiques dans le traitement du syndrome de détresse respiratoire aiguë

  Raphaël Briot, Maxime Maignan, Stéphane Gennai, Françoise Carpentier, Guillaume Debaty
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  ABSTRACT: La connaissance physiopathologique et épidémiologique du syndrome de détresse respira-toire aiguë (SDRA) a progressé ces dernières années. Différentes pistes thérapeutiques ont été évaluées par des essais cliniques récents. Les médicaments supposés limiter l'inflammation pulmonaire et favoriser la résorption de l'oedème alvéolaire se sont montrés décevants. La cor-ticothérapie (méthylprednisolone) peut être intéressante à la phase aiguë du SDRA mais ne doit pas être utilisée au-delà des deux premières semaines. Les bêta-2-mimétiques, malgré des données préliminaires prometteuses, se sont révélés inefficaces, voire délétères, sur les études prospectives randomisées. La limitation des apports liquidiens semble réduire la formation d'oedème et permet une amélioration des échanges gazeux et un moindre recours à la venti-lation artificielle. Les progrès les plus probants ont été réalisés en développant des stratégies de ventilation protectrice réduisant le barotraumatisme et optimisant le recrutement alvéolaire. La ventilation non invasive au masque est peu recommandée en dehors des formes précoces peu hypoxiques. Les thérapeutiques complexes comme le décubitus ventral, la ventilation haute fréquence, le NO ou les échanges gazeux extracorporels restent des thérapeutiques d'exception dont l'efficacité et la place sont à préciser. Mots clés : SDRA, oedème pulmonaire, inflammation pulmonaire U n syndrome de détresse respira-toire aiguë (SDRA) est présent chez de nombreux patients de réani-mation. Plusieurs causes peuvent être à l'origine des lésions pulmonaires inflammatoires regroupées sous cette appellation. Si la physiopathologie de ce syndrome est mieux connue, les pistes pharmacologiques explorées ces dernières années sont déce-vantes. L'optimisation de certaines prises en charge, comme un remplis-sage vasculaire limité et surtout un meilleur réglage de la ventilation arti-ficielle permettent une baisse de la morbi-mortalité.
  Medecine Therapeutique 09/2012; 18(3):205-212.
• Article: Regional system of care for ST-segment elevation myocardial infarction in the Northern Alps: A controlled pre- and postintervention study.

  José Labarère, Loic Belle, Magali Fourny, Gérald Vanzetto, Guillaume Debaty, David Delgado, Julien Brallet, Benoît Vallet, Nicolas Danchin
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  ABSTRACT: BACKGROUND: Regionalization of care for ST-segment elevation myocardial infarction (STEMI) has been advocated, although its effect on processes of care and clinical outcomes remains uncertain. AIM: To assess the impact of a regional system of care on provision of reperfusion therapy for STEMI patients relative to control hospitals. METHODS: We analysed the original data from two nationwide prospective cohort studies conducted in 2000 and 2005, respectively. Overall, 160 hospitals participated in both studies, including seven hospitals involved in a regional system of care implemented in the Northern Alps in 2002 and 153 control hospitals located in other French areas. RESULTS: A total of 102 and 2377 STEMI patients were enrolled in Northern Alps and control hospitals, respectively. Overall, patients enrolled in 2005 were more likely to receive any reperfusion therapy (60% vs 52%; P<0.001), prehospital fibrinolysis (33% vs 15%; P<0.001), and primary percutaneous coronary intervention (32% vs 26%; P<0.001) than those enrolled in 2000. However, the regional system of care was associated with a larger absolute change in the use of prehospital fibrinolysis (45.0 vs 17.0; P=0.02) and rescue or early routine coronary angiography or intervention after fibrinolysis (35.3 vs 15.2; P=0.01). Patients enrolled in 2005 had lower adjusted hazard ratios for death (0.70, 95% confidence interval 0.57-0.87; P=0.001), with no significant interaction between study groups. CONCLUSION: Regionalization of care for STEMI patients improves access to reperfusion therapy, although its impact on clinical outcomes deserves further study.
  Archives of cardiovascular diseases 08/2012; 105(8-9):414-423. · 0.66 Impact Factor
• Article: Inappropriate dispatcher decision for emergency medical service users with acute myocardial infarction.

  Magali Fourny, Anne-Sophie Lucas, Loïc Belle, Guillaume Debaty, Pierre Casez, Hélène Bouvaist, Patrice François, Gérald Vanzetto, José Labarère
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  ABSTRACT: Current guidelines recommend utilization of prehospital emergency medical services (EMSs) by patients with ST-elevation myocardial infarction (STEMI). The aims of this study were to estimate the percentage of inappropriate initial dispatcher decisions and determine their impact on delays in reperfusion therapy for EMS users with STEMI. As part of a prospective regional registry of patients with STEMI, we analyzed the original data for 245 patients who called a university hospital-affiliated EMS call center in France. The primary study outcome was time to reperfusion therapy calculated from the documented date and time of the first patient call. The initial EMS dispatcher's decision was appropriate (ie, dispatching a mobile intensive care unit staffed by an emergency or critical care physician) for 171 (70%) patients and inappropriate for 74 (30%) patients. Inappropriate decisions included referring the patient to a family physician (n = 59), providing medical advice (n = 9), and dispatching an ambulance (n = 6). Inappropriate initial decisions resulted in increased median time to reperfusion for 140 patients receiving fibrinolysis (95 vs 53 minutes; P < .001) and 91 patients undergoing primary percutaneous coronary intervention (170 vs 107 minutes; P < .001). In-hospital mortality was not different between the 2 study groups (6.8% vs 9.9%; P = .42). The initial dispatcher's decision is inappropriate for 30% of EMS users with STEMI and results in substantial delays in time to reperfusion therapy. Accuracy of telephone triage should be improved for patients who activate EMSs in response to symptoms suggestive of acute coronary syndrome.
  The American journal of emergency medicine 01/2011; 29(1):37-42. · 1.54 Impact Factor
• Article: Immediate prehospital hypothermia protocol in comatose survivors of out-of-hospital cardiac arrest.

  Laure Hammer, François Vitrat, Dominique Savary, Guillaume Debaty, Charles Santre, Michel Durand, Geraldine Dessertaine, Jean-François Timsit
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  ABSTRACT: Therapeutic hypothermia (TH) improves the outcomes of cardiac arrest (CA) survivors. The aim of this study was to evaluate retrospectively the efficacy and safety of an immediate prehospital cooling procedure implemented just after the return of spontaneous circulation with a prehospital setting. During 30 months, the case records of comatose survivors of out-of-hospital CA presumably due to a cardiac disease were studied. A routine protocol of immediate postresuscitation cooling had been tested by an emergency team, which consisted of an infusion of large-volume, ice-cold intravenous saline. We decided to assess the efficacy and tolerance of this procedure. A total of 99 patients were studied; 22 were treated with prehospital TH, and 77 consecutive patients treated with prehospital standard resuscitation served as controls. For all patients, TH was maintained for 12 to 24 hours. The demographic, clinical, and biological characteristics of the patients were similar in the 2 groups. The rate of patients with a body temperature of less than 35 degrees C upon admission was 41% in the cooling group and 18% in the control group. Rapid infusion of fluid was not associated with pulmonary edema. After 1 year of follow-up, 6 (27%) of 22 patients in the cooling group and 30 (39%) of 77 patients in the control group had a good outcome. Our preliminary observation suggests that in comatose survivors of CA, prehospital TH with infusion of large-volume, ice-cold intravenous saline is feasible and can be used safely by mobile emergency and intensive care units.
  The American journal of emergency medicine 07/2009; 27(5):570-3. · 1.54 Impact Factor
• Article: [Evolution of strategies of revascularisation in acute coronary syndromes with ST elevation. Analysis of the data of RESURCOR].

  G Debaty, L Belle, J Labarere, M Fourny, J P Torres, D Savary, P Usseglio, E Menthonnex, O Guenot, G Vanzetto
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  ABSTRACT: The aim of this study was to describe the changes in strategy of revascularisation in acute coronary syndromes with ST elevation (ACS ST+) since setting up a health care network. The authors analysed the incidence of coronary angioplasty and of intravenous thrombolysis from a prospective permanent hospital register of patients with ACS ST+ in the three Northern Alps departments from october 1st 2002 to december 31st 2004. Respectively, 171 patients were enrolled in 2002 and 675 in 2003, and 588 in 2004. The use of percutaneous coronary intervention increased (57, 69, and 78% in 2002, 2003, 2004, p< 0.01) in relation to the increased use of immediate secondary percutaneous coronary intervention (27, 36, 43%, p< 0.01) although the use of primary percutaneous coronary intervention did not changed (30, 33, 35%, p= 0.17). These results were observed in hospitals with and without Percutaneous Coronary Intervention facilities. An increase in prehospital (49, 67, 68%, p= 0.02) and hospital thrombolysis (48, 68, 73%, p= 0.03) was only observed in patients managed in institutions without Percutaneous Coronary Intervention facilities. The average delay to arterial punction (120. 124, 100 minutes, p< 0.01) and to intravenous thrombolysis (40, 30, 25 minutes, p< 0.01) decreased during the same period. Patients with ACS ST+ more commonly benefit from coronary revascularisation at increasingly shorter intervals to treatment. This would seem to be related to the better coordination of practitioners after the implantation of a health care network.
  Archives des maladies du coeur et des vaisseaux 03/2007; 100(2):105-11. · 0.40 Impact Factor