O Paut

Aix-Marseille Université, Marsiglia, Provence-Alpes-Côte d'Azur, France

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Publications (104)100.12 Total impact

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    ABSTRACT: Since 2005, forgoing live-support (FLS) is allowed by the French law (known as the Leonetti law) for end-of-life patients only. This study aims at describing the variations over time in the use of the following methods to end life: FLS, brain death and cardiopulmonary resuscitation failure (CPR failure). It is a single retrospective study from 2007 to 2012. The Cochran-Armitage trend test is used in the statistical analysis. Over six years, 263 of the 5100 children who were hospitalized in our intensive care unit died, which represents a 5.2% mortality rate. FLS increased yearly from 31% of the deaths in 2007, to 71% in 2012 (P=0.0008). The rate of CPR failure decreased over the same period (P=0.0015). The rate of brain death remained constant. Following to the Leonetti law, FLS increase, and palliative cares develop without any increase of mortality.
    Annales francaises d'anesthesie et de reanimation 06/2014; · 0.77 Impact Factor
  • Marc Labenne, Olivier Paut
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    ABSTRACT: International guidelines have been edited for cardiac arrest resuscitation in children. The incidence is 10 to 15 fold lower than in adults. The leading cause of out-of-hospital cardiac arrest is respiratory, and shock-resistant cardiac rhythms are more frequent than in adults. Near half of the in-hospital cardiac arrests occur in the perioperative setting. Loss of consciousness and respiratory movements associated with no perception of heart beats. Head extension is performed to ensure airways patency and insuflation is associated to lower sternum 100–120/min compressions with thumbs or palms according to the size of the child. Ventilation in 100% oxygen may worsen neurological prognosis. Cardiac shock is performed with a 4 J/kg current intensity. Intraosseous infusion is possible whenever intravenous infusion is not. Ten μg/kg boluses of epinephrine can be repeated every 3–5 minutes but sodium bicabonates are contraindicated. EtCO2 and SpO2 are monitored during resuscitation. There are no defined criteria to terminate resuscitation in case of failure. When cardiac activity recovers, the hemodynamic status may remain unstable for hours and ischaemic encepalopathy may develop. Induced-hypothermia has no demonstrated benefit in children. In-hospital cardiac arrests convey a higher incidence of recovery of cardiac activity. International guidelines support the presence of relative during resuscitation. Learning resuscitation in paediatrics needs to be developed through simulation.
    Le Praticien en Anesthésie Réanimation 02/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Since 2005, forgoing live-support (FLS) is allowed by the French law (known as the Leonetti law) for end-of-life patients only. This study aims at describing the variations over time in the use of the following methods to end life: FLS, brain death and cardiopulmonary resuscitation failure (CPR failure). It is a single retrospective study from 2007 to 2012. The Cochran-Armitage trend test is used in the statistical analysis. Over six years, 263 of the 5100 children who were hospitalized in our intensive care unit died, which represents a 5.2% mortality rate. FLS increased yearly from 31% of the deaths in 2007, to 71% in 2012 (P = 0.0008). The rate of CPR failure decreased over the same period (P = 0.0015). The rate of brain death remained constant. Following to the Leonetti law, FLS increase, and palliative cares develop without any increase of mortality.
    Annales francaises d'anesthesie et de reanimation 01/2014; · 0.77 Impact Factor
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    ABSTRACT: Purpose: Acute myopathy of intensive care has been described infrequently in children and never after organ transplantation. We report a case of acute myopathy of intensive care in a child after heart transplantation. Clinical features: An II-yr-old girl, with no previous medical history, developed acute cardiomyopathy leading to cardiac shock. Family history revealed four cases of unidentified myopathy and/or cardiomyopathy. Preoperatively, while muscle biopsy was near normal, myocardial biopsy revealed non specific mitochondrial disorders. A few days after heart transplantation, she developed acute hypotonia and flaccid quadriplegia, consistent with the diagnosis of acute myopathy of intensive care. Nerve conduction studies were normal, electromyography showed myopathic changes and a new muscle biopsy from quadriceps femoris showed severe loss of myosin filaments and ATPase activity in type 2 fibres. A large laboratory screening failed to demonstrate a metabolic disease or a known myopathy. Muscle strength recovered progressively in three weeks allowing home discharge. A few months later, she was free of symptoms and muscle biopsy showed full histopathological recovery. Conclusion: Acute myopathy of intensive care can occur in children after heart transplantation. It should be suspected in the presence of muscle weakness and difficulty in weaning from ventilatory support. Electromyography confirmed a myogenic process and muscle biopsy allowed diagnosis. Full clinical and histopathological recovery usually occur within three weeks. Objectif: La myopathie aiguë de réanimation a été rarement décrite en pédiatrie, et jamais après transplantation d’organe chez l’enfant. Nous rapportons un cas pédiatrique de myopathie aiguë de réanimation après transplantation cardiaque. Éléments cliniques: Une enfant de II ans, sans antécédent, est hospitalisée pour choc cardiogénique sur cardiomyopathie aiguë. Dans sa fratrie, on note l’existence de myopathies et de cardiomyopathies non déterminées. La biopsie musculaire préopératoire est normale et la biopsie myocardique montre des anomalies mitochondriales non spécifiques. Quelques jours après une transplantation cardiaque, elle présente une hypotonie globale avec tétraplégie flasque. Une myopathie aiguë de réanimation, évoquée devant des vitesses de conduction nerveuses normales et un tracé électromyographique montrant une atteinte musculaire, est confirmée par une biopsie musculaire montrant une perte des fibres de myosine par dépolymérisation, avec perte de l’activité ATPasique dans les fibres de type 2. La recherche élargie d’une myopathie chronique ou d’une maladie métabolique est négative. En quelques semaines, l’enfant a progressivement récupéré sa force musculaire. Une biopsie musculaire, réalisée à distance, montre une architecture musculaire et une activité enzymatique normales. Conclusion: Une myopathie aiguë de réanimation peut se développer chez le transplanté pédiatrique, puisque des facteurs favorisants sont utilisés pour l’immunosuppression. Elle doit être évoquée devant une faiblesse musculaire et des difficultés de sevrage de la ventilation artificielle. L’électromyogramme objective un processus myogénique et c’est la biopsie musculaire qui permet le diagnostic. La récupération de la force musculaire et histopathologique est obtenue en quelques semaines.
    Canadian Journal of Anaesthesia 04/2012; 47(4):342-346. · 2.13 Impact Factor
  • Child s Nervous System 03/2012; 28(7):1121-4. · 1.24 Impact Factor
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    ABSTRACT: We report 2 cases of children with group A streptococcus pyogenes pleuropneumonia, in one child associated with Kawasaki disease and in the other with streptococcal toxic shock syndrome. These 2 features, with theoretically well-defined clinical and biological criteria, are difficult to differentiate in clinical practice, however, likely due to their pathophysiological links. In case of clinical doubt, an echocardiography needs to be performed to search for coronary involvement and treatment including intravenous immunoglobulins, and an antibiotic with an anti-toxin effect such as clindamycin has to be started early.
    Archives de Pédiatrie 12/2011; 18(12):1310-4. · 0.36 Impact Factor
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    ABSTRACT: We report 2 cases of children with group A streptococcus pyogenes pleuropneumonia, in one child associated with Kawasaki disease and in the other with streptococcal toxic shock syndrome. These 2 features, with theoretically well-defined clinical and biological criteria, are difficult to differentiate in clinical practice, however, likely due to their pathophysiological links. In case of clinical doubt, an echocardiography needs to be performed to search for coronary involvement and treatment including intravenous immunoglobulins, and an antibiotic with an anti-toxin effect such as clindamycin has to be started early.
    Archives De Pediatrie - ARCHIVES PEDIATRIE. 12/2011;
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    ABSTRACT: Mushroom intoxication due to Amanita proxima poisoning is characterized by moderate gastrointestinal symptoms, followed by severe acute renal failure and sometimes by hepatic cytolysis. This syndrome was described in the 1990s in the southeast of France; we report here the first pediatric case, requiring dialysis but achieving complete recovery. The mother of this 11-year-old boy, who had eaten the same mushrooms but in smaller quantities, had only biological renal and hepatic involvement.
    Archives de Pédiatrie 12/2011; 18(12):1290-3. · 0.36 Impact Factor
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    ABSTRACT: Mushroom intoxication due to Amanita proxima poisoning is characterized by moderate gastrointestinal symptoms, followed by severe acute renal failure and sometimes by hepatic cytolysis. This syndrome was described in the 1990s in the southeast of France; we report here the first pediatric case, requiring dialysis but achieving complete recovery. The mother of this 11-year-old boy, who had eaten the same mushrooms but in smaller quantities, had only biological renal and hepatic involvement.
    Archives De Pediatrie - ARCHIVES PEDIATRIE. 12/2011;
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    ABSTRACT: Histiocytoid cardiomyopathy is a rare disease which occurs predominantly in the first two years of life, with a female preponderance. We report the cases of two girls (11 and 15-month-old) which were respectively referred to our institution for ventricular tachycardia and ventricular fibrillation without prodroma. Etiologic findings only showed mild cardiomyopathy. Autopsy and histologic examination led to the diagnosis of histiocytoid cardiomyopathy. Furthermore, in the first observation, agenesis of the corpus callosum was found.
    Annales de Pathologie 04/2011; 31(2):93-7. · 0.24 Impact Factor
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    ABSTRACT: To study the effects of tezosentan, a dual ETA and ETB receptor antagonist on the cardiopulmonary profile in a fetal lamb model of CDH in utero. A diaphragmatic hernia was surgically created at day 75 of gestation. During 45 min of tezosentan perfusion (1 mg/kg), hemodynamic parameters (pulmonary and aortic pressures, left pulmonary and aortic flows, left auricle pressure, heart rate) were measured at day 135 of gestation. Age-matched fetal lambs served as control animals. Secondarily, parietal tension of vessels rings of pulmonary arteries was assessed in organ baths under increasing concentration of tezosentan. In CDH group, under perfusion of tezosentan, pulmonary artery pressure decreased from 45.8 ± 4.1 to 37.6 ± 5.9 mmHg (P < 0.05). Pulmonary artery flow and pulmonary vascular resistance remained constant. In control group, pulmonary artery flow increased from 153.9 ± 15.8 to 233.4 ± 26 ml/min (P < 0.05). Pulmonary artery pressure did not vary. Subsequently calculated pulmonary vascular resistance decreased. In organ bath, no significant relaxation was observed. In this fetal lamb model of CDH, tezosentan decreased pulmonary artery pressure but did not modify pulmonary blood flow. Endothelin may play a role in the regulation of pulmonary vascular tone in utero.
    Pediatric Surgery International 03/2011; 27(3):295-301. · 1.22 Impact Factor
  • Y Asencio, F Voillet, O Paut
    Archives de Pédiatrie 06/2010; 17(6):987-8. · 0.36 Impact Factor
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    ABSTRACT: The aim of this study is to evaluate the outcome of young children hospitalized for non-accidental head trauma in our PICU, to evaluate PRISM II score in this sub-population of pediatric trauma and to identify factors that might influence the short-term outcome. Files of all children less than 2 years old with the diagnosis of non-accidental head trauma over a 10-years period were systematically reviewed. We collected data on demographic information, medical history, clinical status, and management in the PICU. Three severity scores were then calculated: PRISM II, Glasgow Coma Scale (GCS), and Pediatric Trauma Score (PTS). Prognosis value of qualitative variables was tested with a univariate procedure analysis (anemia, diabetes insipidus...). Then, quantitative variables were tested with univariate procedure too (age, weight, PRISM II, GCS, Platelet count, fibrin, prothrombin time (PT)...). Potential association between variables and death was tested using univariate procedure. Variables identified by univariate analysis were then analyzed with multivariate analysis through a forward-stepping logistic regression. Thirty-six children were included. Mean age was 5.5 months (8 days-21.5 months). Mortality rate was 27.8%. At admission, PTS, PRISM II, GCS, PT, PTT, and diabetes insipidus were significantly altered or more frequent in non survivors. Cutoff value for PRISM II at which risk of mortality increased was 17.5 (sensitivity = 0.8; specificity = 0.88). PRISM II is a reliable and easy performing tool for assessing the prognosis of non-accidental cranial traumatism in young children. GCS and PTS, scores even simpler than PRISM II, showed good accuracy regarding survival prediction.
    Child s Nervous System 05/2010; 26(11):1555-61. · 1.24 Impact Factor
  • Y. Asencio, F. Lamy, O. Paut
    Annales Francaises D Anesthesie Et De Reanimation - ANN FR ANESTH REANIM. 01/2010; 29(7):570-572.
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    ABSTRACT: Accidental drownings are severe and sometimes mortal events in children. Our study aims to better clarify the epidemiology and the respiratory complications of these accidents in our hospital. We led a retrospective study over 10 years concerning the children hospitalized for accidental drowning in our hospital centre. Age at the moment of the accident, sex, history of accident, hospitable care, thoracic imaging and neurological outcome of the children were studied. In total, 83 children were hospitalized (5 years on average, 70% being boys). The drowning especially took place in fresh water (71%), particularly in swimming pools (51.8%). Stages III and IV of drowning concerned 40.9% of the population. The coverage was the following one: admittance in ICU 57.8%, mechanical ventilation 34.9%, oxygen therapy 16.9%, antibiotics 87.9%. A normal chest x-ray was present in 45.7% of the cases. Drowning in fresh water, especially in contaminated fresh water (canal, WC, etc.), induced atelectasis (10.8%), whereas drowning in sea water induced diffuse infiltrates (8.4%). Aspiration pneumonia (33.7%) was present in both cases and a pulmonary oedema (6%) was only noticed during stage IV drowning. The secondary infections were rare (1 case was suspected and another probable). A child presented a secondary acute respiratory distress syndrome (1.2 %). Finally, 7 deaths (8.4%) and 1 case with severe neurological sequelae (1.2%) were noted. Accidental drowning causes important consequences in children. The long-term respiratory outcomes have not been properly studied. Prevention of such accidents is based on parental vigilance during their child's bathe.
    Archives de Pédiatrie 11/2009; 17(1):14-8. · 0.36 Impact Factor
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    ABSTRACT: Pertussis is a leading cause of death from community infections in infant. Life-threatening clinical presentations of pertussis can associate multiple organ system failure with respiratory distress. The question of the optimal management of these severe forms of pertussis, in order to reduce the high mortality rate, is raised by the clinicians caring for such patients. We report the case of a 1 month infant who was admitted to the pediatric intensive care unit (PICU) for a severe pertussis. He presented with an acute respiratory distress syndrome, a severe pulmonary hypertension was treated initially with mechanical ventilation and nitric oxide. At day 4 (D4), a cardiogenic shock occurred and, despite epinephrine and norepinephrine infusion, fluid expansion, the hemodynamic condition worsened with two episodes of cardiac arrest. The child was then successfully resuscitated, and, facing the extreme hemodynamic instability, extracorporeal membrane oxygenation (ECMO) was considered. ECMO allowed epinephrine and norepinephrine to be progressively discontinued, and protective mechanical ventilation. ECMO withdrawal was possible at D9, with milrinone as the sole inotropic agent. Weaning from mechanical ventilation was possible on D15 and the total length of stay in PICU was 20days. While the analysis of the literature, through limited experiences on the use of ECMO in children with severe pertussis does not allow concluding definitively on the utility of ECMO in this situation, the contribution of ECMO in the favourable outcome for our patient was considerable. This is an argument, to our opinion, for considering ECMO in the management of those very instable patients.
    Annales francaises d'anesthesie et de reanimation 01/2009; 28(1):74-7. · 0.77 Impact Factor
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    ABSTRACT: Time-domain representations of the fetal aortopulmonary circulation were carried out in lamb fetuses to study hemodynamic consequences of congenital diaphragmatic hernia (CDH) and the effects of endothelin-receptor antagonist tezosentan (3 mg/45 min). From the isthmic aortic and left pulmonary artery (PA) flows (Q) and isthmic aortic, PA, and left auricle pressures (P) on day 135 in 10 controls and 7 CDH fetuses (28 ewes), discrete-triggered P and Q waveforms were modelized as Pt and Qt functions to obtain basic hemodynamic profiles, pulsatile waves [P, Q, and entry impedance (Ze)], and P and Q hysteresis loops. In the controls, blood propelling energy was accounted for by biventricular ejection flow waves (kinetic energy) with low Ze and by flow-driven pressure waves (potential energy) with low Ze. Weak fetal pulmonary perfusion was ensured by reflux (reverse flows) from PA branches to the ductus anteriosus and aortic isthmus as reverse flows. Endothelin-receptor antagonist blockade using tezosentan slightly increased the forward flow but largely increased diastolic backward flow with a diminished left auricle pre- and postloading. In CHD fetuses, the static component overrode phasic flows that were detrimental to reverse flows and the direction of the diastolic isthmic flow changed to forward during the diastole period. Decreased cardiac output, flattened pressure waves, and increased forward Ze promoted backward flow to the detriment of forward flow (especially during diastole). Additionally, the intrapulmonary arteriovenous shunting was ineffective. The slowing of cardiac output, the dampening of energetic pressure waves and pulsatility, and the heightening of phasic impedances contributed to the lowering of aortopulmonary blood flows. We speculate that reverse pulmonary flow is a physiological requirement to protect the fetal pulmonary circulation from the prominent right ventricular stream and to enhance blood flow to the fetal heart and brain.
    AJP Heart and Circulatory Physiology 10/2008; 295(6):H2231-41. · 4.01 Impact Factor
  • O Paut
    Annales francaises d'anesthesie et de reanimation 04/2008; 27(3):e17-20. · 0.77 Impact Factor
  • O. Paut
    Annales Francaises D Anesthesie Et De Reanimation - ANN FR ANESTH REANIM. 01/2008; 27(3).
  • Source
    01/2008;