Guillaume Bossard

Centre Hospitalier Universitaire de la Réunion, Réunion, Reunion

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Publications (9)9 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Stress cardiomyopathy (SC) is a transient ventricular dysfunction rarely described in the critical care setting. Objective: To evaluate the mechanisms, incidence, treatment and prognosis of SC. Method: This is a retrospective observational study of every critically-ill patient admitted to the ICU over a period of two years. Results: Among 1314 patients admitted in the ICU, 20 patients (1.5%) were diagnosed with SC. A total of 249 patients experienced cardiogenic shock, whereas 8% were suffering from SC. SC was suspected because of hemodynamic impairment (80% of cases), ECG modifications (15%) and/or dyspnea (15%). SC was apical (typical Tako-tsubo) in 90% and atypical in 10% of cases. Several mechanisms or conditions may explain the occurrence of SC and are may be combined: catecholamine toxicity (45%), psychological stress, seizures or neurological impairment (35%), non-epicardial coronary ischemia (20%) and left ventricular outflow track (LVOT) obstruction (10%). SC could have indirectly caused death by worsening heart failure in three patients and arrhythmias were seen in 40% of patients. SAPS2, renal impairment, malnutrition, norepinephrine infusion and thrombocytopenia were associated with death in the univariate analysis. Catecholamines were required in 85% and intra-aortic balloon pump in 20% of patients. Conclusions: SC is a rare reversible cardiac impairment in the critically-ill patient that can induce arrhythmias and cardiogenic shock. The likely mechanisms are combined: catecholamine toxicity, stress or neurological involvement and less frequently ischemia or LVOT obstruction.
    European Heart Journal: Acute Cardiovascular Care 09/2014; 4(2). DOI:10.1177/2048872614547686
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    ABSTRACT: Purpose: Prediction of arterial thromboembolic events (ATEs) in relation to supraventricular arrhythmia (SVA) has been poorly investigated in the intensive care unit (ICU). We aimed at evaluating CHADS2 and CHA2DS2-VASc scores to predict SVA-related ATE in the ICU. Methods: We conducted a prospective observational study including all the patients except those in the postoperative course of cardiac surgery who presented SVA lasting 30 seconds or longer during their ICU stay. We looked for ATE during ICU stay, at the first and sixth month of follow-up after ICU discharge. Results: During the 15-month study period, 108 (12.8%) of 846 ICU patients experienced SVA with 12 SVA-related ATE occurring 6 days (3; 13) (median, 10%-90% percentiles) after SVA onset. In our SVA patients, CHADS2 score was 2 (0; 5), and CHA2DS2-VASc score 3 (0; 7). Both CHADS2 (odds ratio (OR), 1.6 [1.1; 2.4]; P = .01) and CHA2DS2-VASc scores (OR, 1.4 [1.04; 1.8]; P = .03) were significantly associated with ATE onset. However, the most accurate threshold for predicting ATE was CHADS2 score of 4 or higher. Using a multivariate analysis, only patient's history of stroke was associated with ATE onset (OR, 9.2 [2.4; 35]; P = .001). Conclusion: CHADS2 and CHA2DS2-VASc scores are predictive of SVA-related thromboembolism in the critically ill patient.
    Journal of Critical Care 05/2014; 29(5). DOI:10.1016/j.jcrc.2014.05.010 · 2.00 Impact Factor
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    ABSTRACT: Acute kidney injury (AKI) is common after cardiac surgery, affecting outcome. Early detection of an AKI marker is likely to speed diagnosis and implementation of measures to preserve renal function. In septic shock and unselected ventilated subjects, an increased Doppler renal resistive index (RRI) is a predictor of AKI. This study aims to determine whether RRI would act similarly in the postoperative setting of cardiac surgery. This study included 65 subjects aged more than 60 yr undergoing elective heart surgery with cardiopulmonary bypass (CPB) and at risk of AKI. All presented at least one AKI risk factor [arteritis, diabetes, or serum creatinine (sCr) clearance of 30-60 ml min(-1)] and were haemodynamically stable without arrhythmia. Doppler RRI was measured in the immediate postoperative period (POP) while subjects were ventilated and sedated. AKI was assessed when sCr increased 30% above the preoperative baseline. Eighteen subjects developed AKI between days 1 and 4, with six requiring dialysis. RRI in the POP was increased in AKI [RRI: 0.79 (0.08) with AKI vs 0.68 (0.06) without AKI, P<0.001], correlating to AKI severity [0.68 (0.06) without AKI, 0.77 (0.08) with AKI but no dialysis, and 0.84 (0.03) with AKI and dialysis, P<0.001]. RRI was similar in subjects receiving catecholamines. RRI >0.74 in the POP predicted delayed AKI with high sensitivity and specificity (0.85 and 0.94, respectively). Multivariate analysis showed that AKI was associated with increased RRI and transfusion. RRI used in the immediate POP after cardiac surgery with CPB enabled prediction of delayed AKI and anticipation of its severity.
    BJA British Journal of Anaesthesia 09/2011; 107(6):891-8. DOI:10.1093/bja/aer289 · 4.85 Impact Factor
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    ABSTRACT: Dans l’hémisphère sud, La Réunion est la sentinelle des infections survenant préférentiellement au cours de l’hiver austral, susceptibles de gagner quelques mois plus tard l’hémisphère nord, telle l’infection à A(H1N1)v2009. Nous rapportons les caractéristiques des patients admis en 2009 et 2010 dans notre service de réanimation principalement pour détresse respiratoire aiguë, à la suite d’une infection à A(H1N1)v2009. Les données démographiques, cliniques, biologiques, ainsi que les traitements et le devenir des patients admis pour infection virale à A(H1N1)v2009 exclusivement confirmée par RT-PCR ont été recueillis de façon prospective. Au cours des années 2009 et 2010, 25 patients ont répondu aux critères définis d’infection à A(H1N1)v2009. L’âge médian était de 40,4 (±17,4) ans. La plupart d’entre eux (22/25) présentaient des facteurs de comorbidité: pathologies chroniques, surpoids ou obésité, grossesse, trisomie. Les principaux motifs d’admission en réanimation ont été les pneumonies virales avec tableau de syndrome de détresse respiratoire aiguë. Le recours à la ventilation artificielle a été nécessaire chez 22 des 25 patients, avec recours à des méthodes sophistiquées et réservées à quelques centres au niveau national, telles que les techniques d’oxygénation extracorporelle (ECMO) ou ventilation à haute fréquence (HFO). Au cours des deux années, 12 décès (48 %) sont survenus essentiellement dans des tableaux de défaillance multiviscérale. Au cours des hivers et automnes australs 2009 et 2010 et pendant une période de plusieurs semaines, l’infection à A(H1N1) v2009 a entraîné une surcharge d’activité notable dans les services de réanimation de La Réunion. L’échec de la campagne de vaccination, notamment des personnes à risques, a eu pour conséquence la survenue de nouveaux cas graves en 2010, notamment parmi les personnes à risques. Le recueil de ces données peut aider à la planification et à l’anticipation de la prise en charge d’autres épidémies grippales.
    Bulletin de la Société de pathologie exotique 05/2011; 104(2). DOI:10.1007/s13149-011-0147-3
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    ABSTRACT: In the Southern hemisphere, Réunion Island acts as a sentinel for infections preferentially occurring during the austral winter that are likely to reach the Northern hemisphere a few months later. We relate the main features concerning patients that were admitted during years 2009 and 2010 in our intensive care unit with an A(H1N1)v2009 infection, mainly for acute respiratory distress. Demographic, clinical, and biological data as well as given medications and outcome were prospectively collected among all PCR-confirmed influenza-infected patients. In 2009 and 2010, 25 patients met the criteria. Patients' median age was 40.4 (±17.4) years. Most of them (22/25) had comorbidities such as: chronic diseases, overweight, obesity, pregnancy, and Down syndrome. Maximum bed-occupation rate was 10 days per million inhabitants. Main diagnosis for ICU admission was virus-related pneumonia. Twenty-two out of 25 patients needed mechanical ventilation, some required rescue therapies such as extracorporeal membranous oxygenation (ECMO) or hi-frequency oscillation ventilation (HFOV), both only available in few French hospitals. Within the study period, 12 patients died (48%) mainly of multi-organ failure. Through 2009 and 2010 autumn and winter periods, for several weeks, the A(H1N1)v2009 virus infection resulted in a significant increase of workload in Réunion Island ICUs. In 2010, the failure of the mass immunization campaign, particularly among the at-risk groups, led to severe cases of A(H1N1)v2009 infections, particularly among patients with comorbidities. Our data may contribute toward better management of influenza virus pandemics in the future.
    Bulletin de la Société de pathologie exotique 05/2011; 104(2):97-104.
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    ABSTRACT: Une jeune femme âgée de 19 ans, porteuse d’une maladie de Hodgkin et hospitalisée dans le service d’oncologie pour une autogreffe, a développé, au 20e jour, un tableau de détresse respiratoire avec défaillance multiviscérale fatale, secondaire à une infection par le virus A(H1N1)v2009. L’infection a été acquise en milieu hospitalier en dépit des quelques mesures de prévention mises en place. À cette époque, le vaccin spécifique n’était pas encore disponible localement. À la suite de cette première vague épidémique, la vaccination spécifique a rencontré très peu de succès avec seulement 4 % de la population générale et 3,3 % du personnel de notre hôpital vaccinés. A 19-year-old patient admitted in an oncology unit for an autograft (Hodgkin disease), developed on day 20 a fatal acute respiratory failure and multiple organ failure due to an infection of the A(H1N1)v2009 virus, which was acquired in the hospital, despite partial preventive measures. At that time, the specific vaccine was not available in Réunion. We discuss the nosocomial origin of the infection. Following the epidemic wave, the vaccination rate of the general population and the hospital employees remains very low. Mots clésA(H1N1)v2009–Infection nosocomiale–Pneumopathie–Hodgkin–ECMO–Hôpital–Île de la Réunion KeywordsA(H1N1)v2009–Nosocomial infection–Pneumopathy–Hodgkin–ECMO–Hospital–Réunion
    Bulletin de la Société de pathologie exotique 05/2011; 104(2):105-107. DOI:10.1007/s13149-011-0143-7
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    ABSTRACT: A 19-year-old patient admitted in an oncology unit for an autograft (Hodgkin disease), developed on day 20 a fatal acute respiratory failure and multiple organ failure due to an infection of the A(H1N1)v2009 virus, which was acquired in the hospital, despite partial preventive measures. At that time, the specific vaccine was not available in Réunion. We discuss the nosocomial origin of the infection. Following the epidemic wave, the vaccination rate of the general population and the hospital employees remains very low.
    Bulletin de la Société de pathologie exotique 03/2011; 104(2):105-7.
  • La Presse Médicale 12/2010; 39(12):1333-6. · 1.08 Impact Factor
  • La Presse Médicale 12/2010; 39(12):1333-1336. DOI:10.1016/j.lpm.2010.07.011 · 1.08 Impact Factor