Frédéric Adnet

Université Paris 13 Nord, Île-de-France, France

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Publications (277)940.78 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Bradykinin-mediated angioedema is characterized by transient attacks of localized edema of subcutaneous or submucosal tissues and can be life-threatening when involving the upper airways. The aim of this study was to determine the features of acute attacks that might be associated with admission to an ICU. We carried out a retrospective, multicenter, observational study in consecutive patients attending one of six reference centers in France for acute bradykinin-mediated angioedema attacks. Patients had been hospitalized for an acute episode at least once previously. Acute attacks requiring ICU admission were compared with acute attacks that had not required ICU admission. Overall, 118 acute attacks in 31 patients were analyzed (10 patients with hereditary angioedema, 19 patients with angiotensin-converting enzyme inhibitor-induced angioedema, and two patients with acquired C1-inhibitor deficiency angioedema). In multivariate analysis, upper airway involvement, corticosteroid, and C1-inhibitor concentrate administration were associated with ICU admission. Seven episodes (18%) needed airway protection. The evolution was favorable in 38 of 39 attacks warranting ICU admission: patients were able to get out of the service (mean ICU stay 4±5 days). One death was observed by asphyxiation because of laryngeal swelling. Upper airway involvement is an independent risk factor for ICU admission. Corticosteroid use, which is an ineffective treatment, and C1-inhibitor concentrate use are factors for ICU admission. The presence of upper airway involvement should be a warning signal that the attack may be severe.
    European journal of emergency medicine : official journal of the European Society for Emergency Medicine. 02/2015;
  • Annales de cardiologie et d'angeiologie 02/2015; · 0.21 Impact Factor
  • La Presse Médicale 01/2015; · 1.17 Impact Factor
  • Presse medicale (Paris, France : 1983). 01/2015;
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    ABSTRACT: L’intubation trachéale en urgence est associée à une plus forte incidence de difficultés. Cette difficulté accrue est elle-même associée à une augmentation des complications et de la mortalité. La recherche de critères prédictifs d’une intubation difficile est plus délicate en urgence et moins pertinente. Le recours à des alternatives à l’intubation orotrachéale, l’optimisation de la procédure et l’utilisation de procédures spécifiques limitent la survenue et les conséquences d’une intubation difficile. Le choix d’un matériel, une organisation et un entraînement éprouvés permettent de réduire les conséquences d’un cas d’intubation difficile, prévue ou non. Les nouveaux dispositifs de « vidéoscopie » semblent supérieurs aux techniques classiques d’intubation, en particulier en cas d’intubation difficile. Ils devront très certainement trouver leur place dans les prochains algorithmes de prise en charge des intubations difficiles en urgence, voire, plus globalement, des intubations en urgence. Chaque structure potentiellement confrontée à l’intubation en urgence devrait d’ores et déjà s’interroger sur son choix de matériel et sa stratégie. Abstract Tracheal intubation in emergency is associated with a higher incidence of difficulties, resulting in increased incidence of complications and mortality. The search for criteria predicting difficult intubation is more difficult and less relevant. The use of alternatives to tracheal intubation, such as optimization of the procedure, and use of specific procedures limit the onset and consequences of a difficult intubation. The choice of material, a good organization, and a proven training allow reducing the consequences of a case of difficult intubation, scheduled or not. The new “videoscopic” devices seem to be superior to conventional intubation techniques, especially in case of difficult intubation. They will probably have a good position in the next guidelines for difficult intubation in emergency or, more generally, for emergency intubation. Each structure potentially facing emergency intubation should question her choice of material and its strategy.
    Réanimation 01/2015;
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    ABSTRACT: The optimal therapeutic strategy for patients with high-risk acute coronary syndrome without ST-segment elevation (NSTE-ACS) remains unclear. Our aim was to compare the effectiveness of an early invasive strategy and a delayed invasive strategy in the management of high-risk NSTE-ACS patients. This randomized clinical trial in a primarily pre-hospital setting enrolled patients with chest pain, electrocardiographic criteria for an NSTE-ACS, and at least one criterion of severity (ESC criterion or TIMI score >5). Patients were randomized to either an early invasive strategy (tirofiban infusion and coronary angiography within 6h) or delayed invasive strategy (as per guidelines and physician discretion; coronary angiography within 6h was not advised). The primary endpoint was the cumulative incidence of deaths, myocardial infarctions, or urgent revascularizations at 30days of follow-up. Secondary endpoints were failure of delayed management, length of hospital stay and long-term mortality. Between January 2007 and February 2010, 170 patients were enrolled. The cumulative incidence of adverse outcomes was significantly lower for early invasive than delayed management (2% [95% CI 0-9] vs. 24% [95% CI 16-35], p<10(-4)). Delayed management failed in 24% of cases. The length of hospital stay was significantly shorter in patients undergoing angioplasty or treated with tirofiban within 6h (p=0.0003). Long-term mortality was 16% in both arms after a median follow-up of 4.1years. An early invasive strategy reduced major adverse cardiac events in patients with high-risk NSTE-ACS. Early angiography or tirofiban (GP IIb/IIIa inhibitor) infusion proved necessary in a quarter of patients assigned to delayed management. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    International journal of cardiology. 12/2014; 182C:414-418.
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    ABSTRACT: To evaluate the long-term prognostic effect of resting heart rate (HR) at index myocardial infarction (MI) and during the first year after MI among 1-year survivors. The community-based cohort consisted of 1571 patients hospitalized with an incident MI from January 1, 1983, through December 31, 2007, in Olmsted County, Minnesota, who were in sinus rhythm at index MI and had HR measurements on electrocardiography at index and during the first year after MI. Outcomes were all-cause and cardiovascular deaths. During a median follow-up of 7.0 years, 627 deaths and 311 cardiovascular deaths occurred. Using patients with HRs of 60/min or less as the referent, this study found that long-term all-cause mortality risk increased progressively with increasing HR at index (hazard ratio, 1.62; 95% CI, 1.25-2.09) and even more with increasing HR during the first year after MI (hazard ratio, 2.16; 95% CI, 1.64-2.84) for patients with HRs greater than 90/min, adjusting for clinical characteristics and β-blocker use. Similar results were observed for cardiovascular mortality (adjusted hazard ratio, 1.66; 95% CI, 1.14-2.42; and adjusted hazard ratio, 1.93; 95% CI, 1.27-2.94; for HR at index and within 1 year after MI, respectively). These data from a large MI community cohort indicate that HR is a strong predictor of long-term all-cause and cardiovascular mortality not only at initial presentation of MI but also during the first year of follow-up. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
    Mayo Clinic Proceedings 12/2014; 89(12):1655-63. · 5.81 Impact Factor
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    ABSTRACT: To evaluate the psychological consequences among family members given the option to be present during the CPR of a relative, compared with those not routinely offered the option.
    Intensive Care Medicine 05/2014; · 5.54 Impact Factor
  • Resuscitation 05/2014; 85:S53. · 3.96 Impact Factor
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    ABSTRACT: Chest pain frequently prompts emergency medical services (EMS) call-outs. Early management of acute coronary syndrome (ACS) cases is crucial, but there is still controversy over the relevance of pain severity as a diagnostic criterion. The aim of this study was to determine whether there is a relationship between the severity of chest pain at the time of out-of-hospital emergency care and diagnosis of acute myocardial infarction (AMI). This was a subsidiary analysis of prehospital data collated prospectively by EMS in a large suburb. It concerned patients with chest pain taken to hospital by a mobile intensive care unit. Pain was rated on EMS arrival using a visual analog, numeric or verbal rating scale and classified on severe or not severe according to the pain score. A diagnosis of AMI was confirmed or ruled out on the basis of 2 plasma troponin measurements and/or coronary angiography results. Among the cohort of 2,279 patients included, 234 were suitable for analysis, of which 109 (47%) were diagnosed with AMI. The rate of severe pain on EMS arrival was not significantly different between AMI patients and no myocardial infarction patients (49% [95% CI 40 to 58] and 43% [34 to 52], respectively; P = 0.3; odds ratio 1.3 [0.8 - 2.3] after adjustment for age and gender). In our out-of-hospital emergency setting, the severity of chest pain was not a useful diagnostic criterion for AMI.
    Pain Practice 03/2014; · 2.18 Impact Factor
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    ABSTRACT: The risk of thromboembolic events is increased during air flights, although it remains low limited to a few cases per million. The distance (and duration) of the flight increases the risk, but risk factors related to patient are not documented as well as the role of hypoxia, hypobaric atmosphere, economy class. Different thromboprophylactic strategies have been suggested but not validated. Thromboprophylaxis has been recommended for long distance flights and patients at risk. No one argues against elastic stocking and deambulation. The use of anticoagulants must remain extremely rare based on an individual balance between benefit and side effects.
    Le Praticien en Anesthésie Réanimation 02/2014;
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    ABSTRACT: Background: Combination drug therapy is often used to achieve optimal analgesia in surgery. Paracetamol can be used as one component of an analgesic regime following hepatic resection. Objective: This study was designed to investigate paracetamol and its metabolites by proton NMR spectroscopy in patient urine and to assess whether N-acetyl-p-benzoquinone imine (NAPQI, a hepatotoxic metabolite) formation is increased after liver resection. Method: We studied the excretion of acetaminophen and its metabolites by 5 patients who were operated on for partial liver resection by proton NMR spectroscopy. As an intravenous infusion 1 g of paracetamol was given over 15 min every 6 h during 48 h. The first injection was given in the operating theatre after liver resection was completed. Urine samples were collected before injection (T1) and 24 and 48 h after the first injection (T2 and T3); the samples were frozen and kept at -20°C up to the analysis by NMR spectroscopy. Results: Metabolites of the paracetamol were detected for all patients. Among the discerned metabolites, 4 were identified as metabolites of paracetamol: paracetamol glucuronide, paracetamol sulfate, N-acetyl-L-cysteinyl paracetamol (metabolite of NAPQI) and paracetamol. Their ratios, respectively, were: 46-82.9, 12.6-30.0, 0.5-5.5 and 1.43-3.54%. Conclusion: This study showed that there was no increase in the formation of toxic metabolite (NAPQI) after treatment with paracetamol in these few cases of liver resections. A larger study is necessary to confirm these results. © 2014 S. Karger AG, Basel.
    Pharmacology 01/2014; 93(1-2):18-23. · 1.58 Impact Factor
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    ABSTRACT: Relative adrenal insufficiency (RAI) has been reported as a predictor of mortality in septic patient; however, its effects on mortality and outcomes for critically ill patients remain debatable. The objective of this study was to assess the effect of RAI on prognostic outcomes in patients after out-of-hospital rapid sequence intubation (RSI) and factors associated with the onset of RAI. A prespecified ancillary study of KETASED, a randomized prospective multicenter trial, was conducted. Three hundred ten patients who underwent RSI in an out-of-hospital setting had baseline cortisol and adrenocorticotropic hormone response test measurements within 24 hours of intensive care unit admission and were included. The mean (SD) age was 55 (19) years, with a mean (SD) Sequential Organ Failure Assessment score of 9 (4). Two hundred forty-seven (69%) patients presented with RAI. Baseline characteristics were similar between patients with and without RAI, except for the use of etomidate as a sedative agent (63% of patients with RAI vs 21%, P < .001), and history of chronic kidney disease. There was no difference in terms of 28-day mortality between the 2 groups (21% vs 19%, P = .65) and in terms of other 28-day prognosis end points. In critically ill patients who require RSI, RAI is common and is not associated with worsened outcomes in our cohort.
    Journal of critical care 01/2014; · 2.13 Impact Factor
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    ABSTRACT: Le concept de « Chest Pain Unit » est né aux États-Unis, dans les années 1980. L’intérêt de la transposition, en France, de ce concept américain ne va pas de soi. Une prévalence de facteurs de risque cardiovasculaire et de la maladie coronaire et une organisation de soins urgents radicalement différents en sont les premières limites. L’analyse médico-économique du recours aux « Chest Pain Unit » ne semble pas favorable. La seule expérience française publiée n’apporte pas d’arguments convaincants. En conséquence, dans le système français, le recours précoce au SAMU-Centre 15, la prise en charge médicale préhospitalière et l’accès direct à la salle de cathétérisme ou à l’unité de soins intensifs de cardiologie doivent demeurer la règle. Cette stratégie est associée aux délais de prise en charge les plus courts et à une réduction de morbi-mortalité. L’éducation en ce sens du patient à risque vasculaire (cardiologique et neurologie) doit être favorisée.
    La Presse Médicale 06/2013; 42(6):1039–1041. · 1.17 Impact Factor
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    ABSTRACT: The concept of "Chest Pain Unit" was born in the United States in the 1980s. The interest of the transposition, in France, of this American concept is not obvious. Radical difference in cardiovascular risk factors, coronary heart disease prevalence and in emergency care organization are the first limits. The medico-economic analysis of "Chest Pain Unit" does not seem to be favorable. The only published French experience provides no convincing arguments. In consequence, in the French system, early call to the SAMU-Centre 15, prehospital medical management and direct access to the cath lab or cardiologic ICU must remain the rule. This strategy is associated with time saved and reduced morbidity and mortality. To educate the patient at vascular (cardiologic and neurologic) risk in this sense should be encouraged.
    La Presse Médicale 04/2013; · 1.17 Impact Factor
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    ABSTRACT: BACKGROUND: Only a few cardiac-arrest victims receive external chest compression (ECC) by a bystander. OBJECTIVE: To test the hypothesis that the general public might start ECC more often if they used an automated device rather than a manual massage. METHODS: Web-based public opinion survey based on two short videos, one showing manual ECC and the other automated ECC (Autopulse, Zoll, France). Advantages and disadvantages (perceived efficacy, reproducibility, hazard, apprehension and acceptability) of the two techniques were evaluated on a visual analogue scale (VAS). A VAS of 1-3 was considered to indicate preference for manual ECC, 8-10 for automated ECC and 4-7 for no clear preference. The final global score was the difference between advantage and disadvantage scores. RESULTS: Overall, 1769 persons answered the questionnaire. The median VAS score for each variable was as follows: 7 (25-75 percentiles, 5-9) for efficacy, 8 (3-10) for reproducibility, 5 (3-8) for hazard, 5 (2-8) for apprehension and 5 (2-8) for acceptability. The overall median score indicated that 1034 persons (58%) preferred use of the device, 618 (35%) preferred manual ECC and 117 (7%) had no preference. There was no significant difference in the preference according to gender, education and training in first aid. However, older persons (0) preferred the use of device. CONCLUSIONS: The better 'advantages over disadvantages' score for the automated ECC device over manual ECC indicated that the general public might envisage use of the device. This could contribute to increase the frequency of resuscitation attempts by bystanders.
    Emergency Medicine Journal 04/2013; · 1.78 Impact Factor
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    ABSTRACT: The effect of family presence during cardiopulmonary resuscitation (CPR) on the family members themselves and the medical team remains controversial. We enrolled 570 relatives of patients who were in cardiac arrest and were given CPR by 15 prehospital emergency medical service units. The units were randomly assigned either to systematically offer the family member the opportunity to observe CPR (intervention group) or to follow standard practice regarding family presence (control group). The primary end point was the proportion of relatives with post-traumatic stress disorder (PTSD)-related symptoms on day 90. Secondary end points included the presence of anxiety and depression symptoms and the effect of family presence on medical efforts at resuscitation, the well-being of the health care team, and the occurrence of medicolegal claims. In the intervention group, 211 of 266 relatives (79%) witnessed CPR, as compared with 131 of 304 relatives (43%) in the control group. In the intention-to-treat analysis, the frequency of PTSD-related symptoms was significantly higher in the control group than in the intervention group (adjusted odds ratio, 1.7; 95% confidence interval [CI], 1.2 to 2.5; P=0.004) and among family members who did not witness CPR than among those who did (adjusted odds ratio, 1.6; 95% CI, 1.1 to 2.5; P=0.02). Relatives who did not witness CPR had symptoms of anxiety and depression more frequently than those who did witness CPR. Family-witnessed CPR did not affect resuscitation characteristics, patient survival, or the level of emotional stress in the medical team and did not result in medicolegal claims. Family presence during CPR was associated with positive results on psychological variables and did not interfere with medical efforts, increase stress in the health care team, or result in medicolegal conflicts. (Funded by Programme Hospitalier de Recherche Clinique 2008 of the French Ministry of Health; number, NCT01009606.).
    New England Journal of Medicine 03/2013; 368(11):1008-18. · 54.42 Impact Factor
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    ABSTRACT: BACKGROUND: Medical practice in the media is usually far from reality. Thus, the viewer may be led astray. The world-famous fictional Dr House has to face a difficult diagnosis every week. His practice does not seem to reflect reality. The aim of this study was to assess the diagnosis strategy involved in this television program. METHODS: An observer has previewed the 2011 season. The episode running time, the patient's age and sex, the list of all investigations and interventions, the final diagnosis, and the patient's outcome were collected. Number and proportion of French viewers for each episode were recorded. RESULTS: We analyzed 18 episodes. The median running time was 42.5 (42.1-43.2) minutes. Main patient characters were 12 men (66%) and 6 women (33%); the average age was 31 (22-38) years. There were 225 investigations or interventions reported, averaging 14 (9-15) per episode, representing one examination every 3.1 (2.9-4.8) minutes. The most frequently prescribed investigations were magnetic resonance imaging (MRI; 13; 72%), blood sample (11; 61%), and biopsy (10; 56%). The most frequent interventions were surgery, anti-infectious treatments, and steroid treatments (9 each; 50%). Two patients (11%) died. The median number of spectators was 8.4 (8.1-8.7) million, corresponding to 33% (33%-34%) of the French national audience. CONCLUSION: The population and the examination strategies used by Dr House were unrealistic. Because of this distortion, patients may not understand, nor accept the delay, the investigation choices, the intervention costs, risks, nor failures of a daily medical practice. Physicians should be aware of this "information bias."
    The American journal of medicine 02/2013; 126(2):171-173. · 5.30 Impact Factor
  • P. Jabre, V. Belpomme, F. Adnet
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    ABSTRACT: L’attitude de l’équipe soignante vis-à-vis des proches lors d’une réanimation cardiopulmonaire (RCP) reste très débattue. Les résultats récents de l’essai clinique « PRESENCE » montrent un effet bénéfique de la proposition à la famille d’assister à la réanimation en termes de stress posttraumatique et de symptômes d’anxiété et de dépression. De plus, la présence de la famille ne semble pas avoir d’influence sur la qualité de la réanimation, le stress de l’équipe soignante, ni le nombre de plaintes. Cette étude augmente le niveau de preuve des recommandations internationales sur la prise en charge de l’arrêt cardiaque qui, depuis 2005, préconisaient d’autoriser la présence des proches lors d’une RCP. Cette stratégie doit être encadrée par une procédure bien définie, un soignant accompagnant les proches et une formation préalable des équipes soignantes. Les études futures devraient viser à améliorer notre compréhension des raisons pour lesquelles la présence des membres de la famille pendant la RCP peut réduire leur souffrance et dans quels systèmes de santé une telle approche pourrait être mise en pratique d’une manière sûre et rentable. Abstract Health care providers’ attitude towards family members during cardiopulmonary resuscitation (CPR) remains highly debated. Recent results from the “PRESENCE” clinical trial show a beneficial effect of offering the family the opportunity to observe CPR in terms of posttraumatic stress disorder and symptoms of anxiety and depression. In addition, family presence does not interfere with medical efforts, increase stress in the health care team, or result in medicolegal conflicts. This study increases the level of evidence of international guidelines for cardiac arrest management that, since 2005, advocated allowing the presence of relatives during CPR. This strategy should be guided by a well-defined protocol, a designated support assistant charged with carefully explaining the resuscitative efforts and prior training of medical staff. Future studies should aim to improve our understanding of why the presence of family members during CPR may reduce their suffering and in what kind of health system such an approach could be implemented in practice in a safe and cost-effective manner.
    Réanimation 01/2013; 23(S2):433-436.
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    ABSTRACT: OBJECTIVE: To assess the practices and opinions of prehospital emergency medical services (EMS) with regard to family witnessed resuscitation (FWR) and to analyse the differences between physicians' and nurses' responses. DESIGN: An anonymous questionnaire (30 yes/no questions on demographics and FWR) was sent to all prehospital emergency staff (physicians, nurses and support staff) working for the 377 Mobile Intensive Care Units in France. RESULTS: Of the 2689 responses received 2664 were analysed. Mean respondent age was 38±8 years, the male to female ratio was 1:2. 87% of respondents had already performed FWR and 38% had offered relatives the option to be present during resuscitation. Most respondents (90%) felt that FWR might cause psychological trauma to the family; 70% thought that FWR might impact on the duration of resuscitation and 68% on EMS team concentration. In the 28% of cases when relatives had asked to be present, 59% of respondents had acquiesced but only 27% were willing to invite relatives to be routinely present. CONCLUSIONS: Prehospital EMS teams in France seems to support FWR but are not yet ready to offer it systematically to relatives. Following our survey, written guidelines are currently in development in our department. These guidelines could be the first step of a national strategy for developing FWR in France. We await results from other studies of family members' opinions to compare prehospital practitioners' and family members' views to further develop our practice.
    Emergency Medicine Journal 12/2012; · 1.78 Impact Factor

Publication Stats

3k Citations
940.78 Total Impact Points


  • 2001–2014
    • Université Paris 13 Nord
      Île-de-France, France
  • 2011
    • Emergency medical services Chile
      CiudadSantiago, Santiago Metropolitan, Chile
  • 2009–2011
    • Hôpital Avicenne – Hôpitaux Universitaires Paris-Seine-Saint-Denis
      Bobigny, Île-de-France, France
    • Hospital de Urgencia de Sergipe
      Aracaju, Sergipe, Brazil
  • 2006–2011
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
  • 2007
    • Académie Nationale de Médecine
      Lutetia Parisorum, Île-de-France, France
  • 1997
    • invivo-AFDIAR
      United States