Thomas Lescot

McGill University, Montréal, Quebec, Canada

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Publications (66)116.83 Total impact

  • The American Journal of Gastroenterology 04/2014; 109(4):607-8. · 7.55 Impact Factor
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    ABSTRACT: Surgical necrosectomy, but is still associated with a high morbidity. Indications of the endoscopic route, a new less invasive technique are not defined yet. To compare characteristics and clinical outcome of patients treated by the two techniques, a bi-centric retrospective comparison of 21 patients treated by surgical necrosectomy in one center (group S) with 11 patients treated in another center by endoscopic transgastric necrosectomy (group E) was performed. Clinical severity scores were significantly higher in group S although CT severity score did not differ between groups. Acute postoperative complications including pancreatic fistula occurred more frequently in group S (86% vs. 27%, P = 0.002). ICU and hospital length of stay were higher in group S (84 vs. 4 days; P = 0.008 and 58 vs. 15 days; P = 0.005 respectively). Long-term complication did not differ between groups. Compared to surgery, endoscopic necrosectomy exhibited lower rate of complications and reduced hospital length of stays. Endoscopic transgastric necrosectomy appears as a safe and effective procedure and has to be included in the therapeutic algorithm of infected pancreatic necrosis.
    Clinics and Research in Hepatology and Gastroenterology. 01/2014;
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    ABSTRACT: Abstract Objectives: To assess outcome and predicting factors 1 year after a severe traumatic brain injury (TBI). Methods: Multi-centre prospective inception cohort study of patients aged 15 or older with a severe TBI in the Parisian area, France. Data were collected prospectively starting the day of injury. One-year evaluation included the relatives-rating of the Dysexecutive Questionnaire (DEX-R), the Glasgow Outcome Scale-Extended (GOSE) and employment. Univariate and multivariate tests were computed. Results: Among 257 survivors, 134 were included (mean age 36 years, 84% men). Good recovery concerned 19%, moderate disability 43% and severe disability 38%. Among patients employed pre-injury, 42% were working, 28% with no job change. DEX-R score was significantly associated with length of education only. Among initial severity measures, only the IMPACT prognostic score was significantly related to GOSE in univariate analyses, while measures relating to early evolution were more significant predictors. In multivariate analyses, independent predictors of GOSE were length of stay in intensive care (LOS), age and education. Independent predictors of employment were LOS and age. Conclusions: Age, education and injury severity are independent predictors of global disability and return to work 1 year after a severe TBI.
    Brain Injury 06/2013; · 1.51 Impact Factor
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    ABSTRACT: BACKGROUND: After pancreaticoduodenectomy, severe pancreatic fistula may require salvage relaparotomy in patients with largely disrupted pancreaticojejunal anastomosis. Completion pancreatectomy remains the gold standard but yields high mortality and severe long-term repercussions. The authors report the results of a pancreas-preserving strategy used in this life-threatening condition. METHODS: Two hundred fifty-four pancreaticoduodenectomies with pancreaticojejunal anastomosis were performed between 2005 and 2011; 21 patients underwent salvage relaparotomy for grade C pancreatic fistula. Largely dehiscent pancreaticojejunal anastomoses were dismantled in 16 patients. Four patients underwent completion pancreatectomy, whereas in 12 patients detailed here, the remaining pancreas was preserved and drained by wirsungostomy with exteriorization or closure of the jejunal stump. Repeat pancreaticojejunal anastomosis was later planned to preserve pancreatic function. RESULTS: One patient died of recurrent hemorrhage on day 1 after wirsungostomy (8.3%). All but 1 survivor developed postoperative complications, and 3 needed reoperation before hospital discharge. The median hospital stay was 62 days (range, 29 to 156 days). After a median delay of 130 days (range, 91 to 240 days) from salvage relaparotomy, repeat pancreaticojejunostomy was attempted in 10 patients and was successful in 9 (1 completion pancreatectomy was performed). One patient died postoperatively (10%). Long-term endocrine function was unaltered in 66% of patients who benefited from this conservative strategy. CONCLUSIONS: This pancreas-preserving strategy yielded a whole mortality rate of 17% for largely disrupted pancreaticojejunal anastomosis requiring salvage relaparotomy. It compares favorably with systematic completion pancreatectomy and achieved preservation of remnant pancreatic function in 75% of patients.
    American journal of surgery 05/2013; · 2.36 Impact Factor
  • Article: In reply.
    Anesthesiology 05/2013; 118(5):1237. · 5.16 Impact Factor
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    ABSTRACT: Delirium is common in intensive care unit patients and is associated with worse outcome. To identify early risk factors for delirium in patients admitted to the intensive care unit following orthotopic liver transplantation (OLT). An observational study of patients admitted to the intensive care unit from January 2000 to May 2010 for elective or semi-elective OLT was conducted. The primary end point was delirium in the intensive care unit. Pre- and post-transplantation and intraoperative factors potentially associated with this outcome were examined. Of the 281 patients included in the study, 28 (10.03%) developed delirium in the intensive care unit at a median of two days (interquartile range one to seven days) after OLT. According to multivariate analysis, independent risk factors for delirium were intraoperative transfusion of packed red blood cells (OR 1.15 [95% CI 1.01 to 1.18]), renal replacement therapy during the pretransplantation period (OR 13.12 [95% CI 2.82 to 72.12]) and Acute Physiologic and Health Evaluation (APACHE) II score (OR per unit increase 1.10 [95% CI 1.03 to 1.29]). Using Cox proportional hazards models adjusted for baseline covariates, delirium was associated with an almost twofold risk of remaining in hospital, a fourfold increased risk of dying in hospital and an almost threefold increased rate of death by one year. Intraoperative transfusion of packed red blood cells, pretransplantation renal replacement therapy and APACHE II score are predictors for the development of delirium in intensive care unit patients post-OLT and are associated with increased hospital lengths of stay and mortality.
    Canadian journal of gastroenterology = Journal canadien de gastroenterologie 04/2013; 27(4):207-12. · 1.53 Impact Factor
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    ABSTRACT: INTRODUCTION: Critically ill cirrhotic patients awaiting liver transplantation (LT) often receive prioritization for organ allocation. Identification of patients most likely to benefit is essential. The purpose of this study was to examine whether the Sequential Organ Failure Assessment (SOFA) score can predict 90-day mortality in critically ill recipients of LT and whether it can predict receipt of LT amongst critically ill cirrhotics listed awaiting LT. METHODS: Multi-center retrospective cohort study consisting of two datasets: 1) all critically-ill cirrhotic patients requiring intensive care unit (ICU) admission prior to LT at five transplant centers in Canada from 2000-2009 (one site 1990-2009) and 2) critically ill cirrhotics receiving LT from ICU (n=115) and those listed but not receiving LT prior to death (n=106) from two centres where complete data was available. RESULTS: In the first dataset, 198 critically ill cirrhotics receiving LT (mean [SD] age 53 [10] years, 66% male, median [IQR] model for end-stage liver disease (MELD) 34 [26-39]) were included. Mean (SD) SOFA scores at ICU admission, at 48 hours, and at LT were 12.5 (4), 13.0 (5) and 14.0 (4). Survival at 90-days was 84% (n=166). In multivariable analysis, only older age was independently associated with reduced 90-day survival (Odds Ratio [OR] 1.07; 95% CI, 1.01-1.14, p=0.013). SOFA score did not predict 90-day mortality at any time-point. In the second dataset, 47.9% (n=106) of cirrhotics listed for LT died in ICU waiting for LT. In multivariable analysis, higher SOFA at 48 hours after admission was independently associated with lower probability of receiving LT (OR 0.89; 95% CI, 0.82-0.97, p=0.006). When including serum lactate and SOFA at 48 hours in the final model, elevated lactate (at 48 hours) was also significantly associated with lower likelihood of receiving LT (0.32; 0.17-0.61, p=0.001). CONCLUSIONS: SOFA appears poor at predicting 90-day survival in critically ill cirrhotics following LT, but higher SOFA score and elevated lactate 48 hours after ICU admission are associated with a lower probability receiving LT. Older critically ill cirrhotics (over 60) receiving LT have worse 90-day survival and should be considered for LT with caution.
    Critical care (London, England) 02/2013; 17(1):R28. · 4.72 Impact Factor
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    Anesthesiology 07/2012; 117(4):898-904. · 5.16 Impact Factor
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    ABSTRACT: The aim of this study in patients with traumatic brain injury (TBI) was to assess the effectiveness of continuous cerebrospinal fluid (CSF) drainage in controlling intracranial pressure (ICP) and minimizing the use of other ICP-lowering interventions potentially associated with serious adverse events. We studied 20 TBI patients. In each patient, we compared four consecutive 12-hour periods covering the 24 hours before CSF drainage (NoDr1 and NoDr2) and the 24 first hours of drainage (Dr1 and Dr2). During each period, we recorded ICP, cerebral perfusion pressure (CPP), sedation, propofol infusion rate, and number of hypertonic saline boluses. With continuous CSF drainage, ICP decreased significantly from 18 ± 6 mmHg (NoDr1) and 19 ± 7 mmHg (NoDr2) to 11 ± 5 mmHg (Dr1) and 12 ± 7 mmHg (Dr2). CPP increased significantly with drainage. Drainage led to a significant decrease in the number of hypertonic saline boluses required for ICP elevation, from 35 in 16 patients (80%) (NoDr1/2) to eight in five patients (25%) (Dr3/4). Drainage was not associated with changes in the midazolam or sufentanil infusion rates. The propofol infusion rate was non-significantly lower with drainage. No significant differences in serum sodium, body temperature, or PaCO(2) occurred across the four 12-hour periods. CSF drainage may not only lower ICP levels, but also decreases treatment intensity during the 24 hours following EVD placement in TBI patients. Because EVD placement may be associated with adverse event, the exact role for each of the available ICP-lowering interventions remains open to discussion.
    Neurochirurgie 05/2012; 58(4):235-40. · 0.32 Impact Factor
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    Critical Care 03/2012; 16(1). · 4.93 Impact Factor
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    ABSTRACT: It is clear that patients with a severe traumatic brain injury (TBI) develop secondary, potentially lethal neurological deterioration. However, it is difficult to predict which patients with mild-to-moderate TBI (MM-TBI), even after intensive care unit (ICU) admission, will experience poor outcome at 6 months. Standard computed tomography (CT) imaging scans provide information that can be used to estimate specific gravity (eSG). We have previously demonstrated that higher eSG measurements in the standard CT reading were associated with poor outcomes after severe TBI. The aim of this study was to determine whether eSG of the intracranial content predicts 6-month outcome in MM-TBI. We analyzed admission clinical and CT scan data (including eSG) of 66 patients with MM-TBI subsequently admitted to our neurosurgical ICU. Primary outcome was defined as a Glasgow Outcome Scale score of 1 to 3 after 6 months. Discriminating power (area under the receiver operating characteristic curve [ROC-AUC], 95% confidence interval) of eSG to predict 6-month poor outcome was calculated. The correlation of eSG with the main ICU characteristics was then compared. Univariate and stepwise multivariate analyses showed an independent association between eSG and 6-month poor outcome (P = 0.001). ROC-AUC of eSG for the prediction of 6-month outcomes was 0.87 (confidence interval: 0.77-0.96). Admission eSG values were correlated with the main ICU characteristics, specifically 14-day mortality (P = 0.004), length of mechanical ventilation (P = 0.01), length of ICU stay (P = 0.045), and ICU procedures such as intracranial pressure monitoring (P < 0.001). In this MM-TBI cohort admitted to the ICU, eSG of routine CT scans was correlated with mortality, ICU severity, and predicted 6-month poor outcome. An external validation with studies that include the spectrum of TBI severities is warranted to confirm our results.
    Anesthesia and analgesia 02/2012; 114(5):1026-33. · 3.08 Impact Factor
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    Vincent Degos, Thomas Lescot, Louis Puybasset
    11/2011; , ISBN: 978-953-307-723-9
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    ABSTRACT: Cerebral vasospasm is a well-documented complication of aneurismal subarachnoid hemorrhage but has not been extensively studied in brain arteriovenous malformations (BAVMs). Here, our purpose was to identify risk factors for cerebral vasospasm after BAVM rupture in patients requiring intensive care unit (ICU) admission. Patients admitted to our ICU from January 2003 to May 2010 for BAVM rupture were included in this observational study. Clinical, laboratory and radiological features from admission to ICU discharge were recorded. The primary endpoint was cerebral vasospasm by transcranial Doppler (TCD-VS) or cerebral infarction (CI) associated with vasospasm. Secondary endpoints included the Glasgow Outcome Scale (GOS) at ICU discharge. Of 2,734 patients admitted to our ICU during the study period, 72 (2.6%) with ruptured BAVM were included. TCD-VS occurred in 12 (17%) and CI in 6 (8%) patients. All patients with CI had a previous diagnosis of TCD-VS. A Glasgow Coma Scale score <8 was a risk factor for both TCD-VS (relative risk (RR), 4.7; 95% confidence interval (95% CI), 1.6 to 26) and CI (RR, 7.8; 95% CI, 0.1 to 63). Independent risk factors for TCD-VS by multivariate analysis were lower Glasgow Coma Scale score (odds ratio (OR) per unit decrease, 1.38; 95% CI, 1.13 to 1.80), female gender (OR, 4.86; 95% CI, 1.09 to 25.85), and younger age (OR per decade decrease, 1.39; 95% CI, 1.05 to 1.82). The risk of a poor outcome (GOS <4) at ICU discharge was non-significantly increased in the patients with TCD-VS (RR, 4.9; 95% CI, 0.7 to 35; P = 0.09). All six patients with CI had poor outcomes. This is the first cohort study describing the incidence and risk factors for cerebral vasospasm after BAVM rupture. Larger studies are needed to investigate the significance of TCD-vasospasm and CI in these patients.
    Critical care (London, England) 08/2011; 15(4):R190. · 4.72 Impact Factor
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    European Journal of Intensive Care Medicine 05/2011; 37(9):1551-2. · 5.17 Impact Factor
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    ABSTRACT: The purpose of this review is to draw up a statement on current knowledge available on perioperative management of Parkinson's disease patients. Review. In France, approximately 150,000 persons suffer from Parkinson's disease, a neurodegenerative disorder of central nervous system. Parkinson's disease results in selective and irreversible loss of dopaminergic neurons in the substantia nigra pars compacta. Medications based on dopaminergic drugs are used to control motor symptoms and improve motor function. Development of surgical approach, especially deep brain stimulation, has revolutionized the medical management of many patients with Parkinson's disease. Anesthesia of these patients remains a challenge for the clinician. The aim of this review is to describe anaesthetic considerations of patients with Parkinson's disease and to discuss management of antiparkinsonians medications during the perioperative period.
    Annales francaises d'anesthesie et de reanimation 04/2011; 30(7-8):559-68. · 0.77 Impact Factor
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    ABSTRACT: To evaluate the in vivo accuracy of the new Pressio(®) device for intraparenchymal monitoring of intracranial pressure (ICP) versus the Codman(®) device and intraventricular measurement external ventricular drainage (EVD). Data were collected retrospectively for 30 consecutive patients admitted into a 25-bed neurosurgical intensive care unit of a university hospital between January and December 2009. Patients received both intraventricular and intraparenchymal ICP monitoring with Pressio(®) (n = 15) or Codman(®) (n = 15). We obtained 3,089 data points from the 30 patients. Mean difference between intraparenchymal and EVD pressure (bias) was -0.6 mmHg, and limits of agreement (1.96 SD of the bias) were -8.1 to 6.9 mmHg with Pressio(®) and 0.3 mmHg with limits of agreement of -6.7 to 7.1 mmHg with Codman(®) (NS). The temporal difference was -0.7 ± 1.6 mmHg/100 h of monitoring with Pressio(®) and 0.1 ± 1.6 mmHg/100 h of monitoring with Codman(®) over the study period (NS). Intraparenchymal pressure measured with both transducers approximates intraventricular cerebrospinal fluid pressure with an accuracy of ±7 mmHg.
    European Journal of Intensive Care Medicine 02/2011; 37(5):875-9. · 5.17 Impact Factor
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    ABSTRACT: La sédation existe dès lors que la VM invasive est instaurée. L’arrêt de la VM qui est l’objectif de la réanimation, passe par une optimisation préalable du couplage sédation-ventilation: sédation la moins profonde possible allant de paire avec des réglages du ventilateur adaptés au patient. Il est donc nécessaire de diminuer l’adaptation du patient au ventilateur (la sédation) et d’optimiser l’adaptation du ventilateur au patient (la ventilation). De même que la sédation doit être comprise comme une analgésie-sédation à la carte allant vers une prise en charge détaillée de l’ensemble des troubles neurologiques et psychologiques chez le patient critique agressé par une réanimation invasive, l’adaptation du ventilateur au patient s’étend à l’adaptation de l’environnement de réanimation au patient allant vers une réanimation minimale invasive, et la moins iatrogénique possible. Le dépistage du prérequis à l’arrêt de la sédation et l’arrêt de la sédation proprement dit sont le préalable indispensable à l’arrêt de la VM qui passe par la recherche quotidienne du prérequis à l’épreuve de ventilation sur pièce en T et sa réalisation. Le couplage sédation-ventilation évoluera probablement vers la période postextubation, avec le développement des techniques de ventilation non invasive, et le recours à un protocole d’analgésie-sédation pour certains patients, comme en VM contrôlée (34).
    01/2011: pages 171-182;
  • N. Bruder, L. Velly, Francis Bonnet, Thomas Lescot
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    ABSTRACT: Les difficultés de sevrage de la sédation doivent être le plus souvent prévenues par une adaptation de la sédation aux besoins du patient, la diminution de la profondeur de la sédation chaque fois que cela est possible, voire son interruption temporaire. Cette attitude est difficile au quotidien et nécessite à la fois une information, une formation et une adhésion de l’ensemble du personnel soignant. Lorsque cela est réalisé, le sevrage de la sédation est une question qui ne se pose pratiquement plus. Mais certains patients ont besoin d’une sédation profonde pendant une durée parfois longue. Lorsque l’état clinique s’améliore, la réévaluation quotidienne de la pertinence de la sédation est une nécessité. Des syndromes de sevrage peuvent alors survenir. Les conséquences physiologiques liées au sevrage de la sédation sont encore mal connues, mais potentiellement délétères sur le système respiratoire, cardio-vasculaire ou sur le système nerveux central. Dans ce cas, il n’y a pas de schéma validé d’arrêt de la sédation, mais la titration en fonction d’un score clinique et le recours éventuel à des agents alpha2-agonistes pour limiter l’hyperactivité sympathique peuvent être recommandés.
    01/2011: pages 105-115;
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    ABSTRACT: Un protocole de sédation-analgésie repose sur l’assemblage de trois composantes que constituent un objectif clair de sédation-analgésie, une évaluation régulière de l’état du patient et un schéma d’adaptation posologique simple et précis au sein d’un algorithme. Cette procédure thérapeutique doit être utilisable au quotidien et requiert un travail important de l’équipe soignante avec une collaboration étroite entre médecins et infirmières.
    01/2011: pages 91-103;
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    ABSTRACT: Même si la sédation-analgésie est un élément majeur de la prise en charge de l’enfant en réanimation, de nombreux travaux sont encore nécessaires pour affiner les connaissances tant cliniques que pharmacologiques dans ce domaine. Dans l’état actuel de la littérature, la plupart des molécules couramment employées en réanimation de l’adulte ou en anesthésie-réanimation pédiatrique peuvent être préconisées pour la réalisation d’une sédation de l’enfant en réanimation, à l’exception notable du propofol. L’adéquation du degré de sédation et d’analgésie nécessite de se doter d’outils d’évaluation adaptés à l’âge et à la pathologie de l’enfant.
    01/2011: pages 225-242;

Publication Stats

220 Citations
116.83 Total Impact Points

Institutions

  • 2013
    • McGill University
      Montréal, Quebec, Canada
    • McGill University Health Centre
      Montréal, Quebec, Canada
  • 2008–2012
    • Hôpital La Pitié Salpêtrière (Groupe Hospitalier "La Pitié Salpêtrière - Charles Foix")
      • Service de Neurochirurgie
      Lutetia Parisorum, Île-de-France, France
  • 2006–2011
    • Pierre and Marie Curie University - Paris 6
      • Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière
      Lutetia Parisorum, Île-de-France, France
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
  • 2009–2010
    • Université René Descartes - Paris 5
      • Faculté des Sciences Pharmaceutiques et Biologiques de Paris
      Paris, Ile-de-France, France