Frédéric Adnet

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

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Publications (292)994.88 Total impact

  • La Presse Médicale 06/2015; DOI:10.1016/j.lpm.2015.04.029 · 1.17 Impact Factor
  • La Presse Médicale 05/2015; DOI:10.1016/j.lpm.2015.03.009 · 1.17 Impact Factor
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    ABSTRACT: Acute attacks of hereditary angioedema are characterized by recurrent localized edema. These attacks can be life threatening and are associated with substantial morbidity and mortality. To determine factors associated with hospital admission of patients with an acute attack of hereditary angioedema presenting at the emergency department. This was a multicenter prospective observational study of consecutive patients (January 2011 through December 2013) experiencing an acute hereditary angioedema attack and presenting at the emergency department at 1 of 4 French reference centers for bradykinin-mediated angioedema. Attacks requiring hospital admission were compared with those not requiring admission. Of 57 attacks in 29 patients, 17 (30%) led to hospital admission. In multivariate analysis, laryngeal and facial involvements were associated with hospital admission (odds ratio 18.6, 95% confidence interval 3.9-88; odds ratio 7.7, 95% confidence interval 1.4-43.4, respectively). Self-injection of icatibant at home was associated with non-admission (odds ratio 0.06, 95% confidence interval 0.01-0.61). The course was favorable in all 57 cases. No upper airway management was required. Most patients attended the emergency department because they were running out of medication and did not know that emergency treatment could be self-administered. Risk factors associated with hospital admission were laryngeal and facial involvement, whereas self-injection of icatibant was associated with a return home. Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 04/2015; 114(6). DOI:10.1016/j.anai.2015.04.005 · 2.75 Impact Factor
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    ABSTRACT: Introduction En France, la régulation médicale est une étape fondamentale dans la gestion des urgences préhospitalières. Il existe très peu de données concernant son enseignement durant le cursus universitaire. L’objectif de ce travail était de réaliser un état des lieux de l’enseignement à la régulation médicale au cours du Diplôme d’Études Spécialisées Complémentaires de Médecine d’Urgence d’Île-de-France (DESC-MU IDF) à la recherche d’éventuelles carences et de pistes d’amélioration pour cette formation. Méthode Il s’agit d’une étude observationnelle, prospective, déclarative, réalisée entre mars et avril 2014, à partir d’un questionnaire s’adressant aux médecins titulaires du DESC-MU IDF des promotions 2012 et 2013. Résultats Les questionnaires ont été envoyés à 177 médecins. Sur les soixante-sept médecins participants (38 %), neuf (13 % [IC95 %:7-24]) ont reçu une formation théorique et pratique à la régulation médicale. Soixante-douze pour cent estiment avoir ressenti des carences de formation au cours de leurs premières régulations en tant que médecin senior. Plus de neuf médecins sur dix recommandent une formation théorique et pratique de la régulation médicale. Conclusion Ce travail met en évidence les carences existantes dans la formation à la régulation médicale au cours de la formation du DESC-MU IDF. Ces résultats doivent faire discuter l’enseignement au niveau de chaque site de stage ainsi qu’au niveau régional, tant sur le plan théorique que pratique.
    03/2015; 5(2):90-94. DOI:10.1007/s13341-015-0510-2
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    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 02/2015; DOI:10.1097/MEJ.0000000000000252 · 1.50 Impact Factor
  • Annales de cardiologie et d'angeiologie 02/2015; DOI:10.1016/j.ancard.2014.12.005 · 0.30 Impact Factor
  • La Presse Médicale 01/2015; 44(3). DOI:10.1016/j.lpm.2014.10.005 · 1.17 Impact Factor
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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; DOI:10.1007/s13546-015-1027-9
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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. DOI:10.1016/j.ijcard.2014.12.089 · 6.18 Impact Factor
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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. DOI:10.1016/j.mayocp.2014.07.017 · 5.81 Impact Factor
  • Annales Françaises d Anesthésie et de Réanimation 09/2014; 33:A192-A193. DOI:10.1016/j.annfar.2014.07.323 · 0.84 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. Prospective, cluster-randomized, controlled trial involving 15 prehospital emergency medical services units in France, comparing systematic offer for a relative to witness CPR with the traditional practice among 570 family members. Main outcome measure was 1-year assessment included proportion suffering post-traumatic stress disorder (PTSD), anxiety and depression symptoms, and/or complicated grief. Among the 570 family members [intention to treat (ITT) population], 408 (72 %) were evaluated at 1 year. In the ITT population (N = 570), family members had PTSD-related symptoms significantly more frequently in the control group than in the intervention group [adjusted odds ratio, 1.8; 95 % confidence interval (CI) 1.1-3.0; P = 0.02] as did family members to whom physicians did not propose witnessing CPR [adjusted odds ratio, 1.7; 95 % CI 1.1-2.6; P = 0.02]. In the observed cases population (N = 408), the proportion of family members experiencing a major depressive episode was significantly higher in the control group (31 vs. 23 %; P = 0.02) and among family members to whom physicians did not propose the opportunity to witness CPR (31 vs. 24 %; P = 0.03). The presence of complicated grief was significantly greater in the control group (36 vs. 21 %; P = 0.005) and among family members to whom physicians did not propose the opportunity to witness resuscitation (37 vs. 23 %; P = 0.003). At 1 year after the event, psychological benefits persist for those family members offered the possibility to witness the CPR of a relative in cardiac arrest.
    Intensive Care Medicine 05/2014; 40(7). DOI:10.1007/s00134-014-3337-1 · 5.54 Impact Factor
  • Resuscitation 05/2014; 85:S53. DOI:10.1016/j.resuscitation.2014.03.134 · 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; 15(4). DOI:10.1111/papr.12178 · 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; DOI:10.1016/j.pratan.2013.10.014
  • Journal of Emergency Medicine 02/2014; 46(2):292. DOI:10.1016/j.jemermed.2013.11.043 · 1.18 Impact Factor
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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. DOI:10.1159/000357095 · 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; DOI:10.1016/j.jcrc.2013.12.018 · 2.19 Impact Factor
  • La Revue de Médecine Interne 12/2013; 34:A55-A56. DOI:10.1016/j.revmed.2013.10.080 · 1.32 Impact Factor

Publication Stats

3k Citations
994.88 Total Impact Points

Institutions

  • 2006–2015
    • Université Paris 13 Nord
      Вильтанез, 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
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
    • Hospital de Urgencia de Sergipe
      Aracaju, Sergipe, Brazil
  • 2007
    • University of Texas at San Antonio
      San Antonio, Texas, United States
  • 1999
    • Case Western Reserve University
      Cleveland, Ohio, United States
  • 1997
    • invivo-AFDIAR
      United States