F Nicolas

Centre Hospitalier Universitaire de Nantes, Naoned, Pays de la Loire, France

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Publications (151)154.97 Total impact

  • E Bironneau · W Martineau · F Nicolas
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    ABSTRACT: Objective: Psychiatric symptoms are often observed in the intensive care unit (ICU). The most frequently described patterns are those of depression, anxiety and delirium. Their correct diagnosis is generally difficult in the ICU as psychiatrists are rarely permanently present, and because we lack precise scales or tools to describe these patients. The aim of this study was to prospectively assess the psychiatric state of all patients admitted in our ICU during 18 months and to design valid tools to detect psychiatric disorders in ICU patients.Methods: Fifty-six signs used in the diagnosis of depression, anxiety and/or delirium were proposed to the clinician in charge of every admitted patient in our ICU during the study period: a total of 1,010 patients were enrolled.Results: Fifty/1,010 (5.3%) of patients presented a psychiatric disorder. Ten to 15 tests turned out to be useful, and were selected for the diagnosis of each syndrome. The ICU somatic disorder was significantly more severe, and the length of stay of patients was significantly longer in those with a psychiatric diagnosis than the others. In general, depression and anxiety appear 15 days after admission in the ICU.Discussion and conclusion: Psychiatric disorders appear generally after 2 weeks in the more severe ICU patients. Simple clinical signs can be used in the ICU to detect anxiety, depression and delirium.RésuméObjectifs: Les principaux syndromes psychiatriques observés en réanimation sont la dépression, l'anxiété et le delirium. Le diagnostic en est rendu difficile par l'absence d'un psychiatre résidant en permanence dans le service de réanimation et par le fait que les réanimateurs ne disposent pas encore d'outils diagnostiques validés dans ce domaine. Le but de cette étude a été d'évaluer de façon prospective l'état psychiatrique des malades admis dans notre service de réanimation pendant 18 mois, afin de mettre sur pied des outils utiles au diagnostic des troubles psychiatriques survenant en réanimation.Méthodes: Cinquante-six signes employés pour le diagnostic de la dépression, de l'anxiété et/ou du delirium ont été proposés aux cliniciens pendant la durée de l'étude. Mille dix malades ont été inclus dans l'étude.Résultats: Cinquante patients (5,3 % du total) ont manifesté un trouble psychiatrique. Dix à 15 tests se sont révélés utiles et ont été choisis pour établir le diagnostic de chaque syndrome. Les malades présentant un trouble psychiatrique souffraient d'une pathologie somatique plus grave que les autres patients et leur séjour en réanimation fut plus long. En règle générale, la dépression et l'anxiété sont apparues environ 15 jours après l'admission en réanimation.Discussion et conclusion: Les affections psychiatriques en réanimation apparaissent généralement 15 jours après l'admission. Des signes cliniques simples permettent aux cliniciens de détecter aisément la dépression, l'anxiété et le delirium.
    Réanimation Urgences 12/1998; 7(6):629-636. DOI:10.1016/S1164-6756(99)80065-6
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    ABSTRACT: Acinetobacter baumannii is an important opportunistic pathogen that is rapidly evolving toward multidrug resistance and is involved in various nosocomial infections that are often severe. It is difficult to prevent A. baumannii infection because A. baumannii is ubiquitous and the epidemiology of the infections it causes is complex. To study the epidemiology of A. baumannii infections and assess the relation between fluoroquinolone use and the persistence of multidrug-resistant clones. Three case-control studies and a retrospective cohort study. A 20-bed medical and surgical intensive care unit. Acinetobacter baumannii was isolated from 45 patients in urine (31%), the lower respiratory tract (26.7%), wounds (17.8%), blood (11.1%), skin (6.7%), cerebrospinal fluid (4.4%), and sinus specimens (2.2%). One death was due to A. baumannii infection. Antimicrobial resistance pattern and molecular typing were used to characterize isolates. The incidence of A. baumannii infection and the use of fluoroquinolones were calculated annually. Initially, 28 patients developed A. baumannii infection. Eleven isolates had the same antimicrobial susceptibility profile, genotypic profile, or both (epidemic cases), and 17 were heterogeneous (endemic cases). A surgical procedure done in an emergency operating room was the main risk factor for epidemic cases, whereas previous receipt of a fluoroquinolone was the only risk factor for endemic cases. The opening of a new operating room combined with the restriction of fluoroquinolone use contributed to a transitory reduction in the incidence of infection. When a third epidemiologic study was done, previous receipt of a fluoroquinolone was again an independent risk factor and a parallel was seen between the amount of intravenous fluoroquinolones prescribed and the incidence of endemic infection. Epidemic infections coexisted with endemic infections favored by the selection pressure of intravenous fluoroquinolones.
    Annals of internal medicine 09/1998; 129(3):182-9. · 16.10 Impact Factor
  • E. Bironneau · W. Martineau · F. Nicolas
    Réanimation Urgences 01/1998; 7.
  • P Le Conte · F Nicolas · C Adjou · J M N'Guyen · E Billaud · P Moreau
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    ABSTRACT: To compare the tolerance and the cost of three replacement fluids in plasmapheresis: albumin 4% alone, albumin 4% + dextran 40, or albumin 4% + hydroxyethylstarch 6%. A one center randomized, cross-over, comparative study designed to explore the tolerance and the colloid oncotic pressure in patients undergoing plasmapheresis. 225 plasmapheresis procedures were performed in 27 patients. Hemodynamic tolerance was good in the three treatment groups. Serum protein concentration after plasmapheresis was significantly lower in the albumin + hydroxyethylstarch group, followed by albumin + dextran 40, versus albumin alone. Colloid oncotic pressure before and after exchange was similar in the three groups. The clinical use of 25-30% of hydroxyethylstarch 6% or dextran 40 with albumin 4% was clinically well tolerated and associated with a 12% decrease of the cost of substitution solutions.
    Intensive Care Medicine 04/1997; 23(3):342-4. DOI:10.1007/s001340050338 · 5.54 Impact Factor
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    ABSTRACT: Animal study results have suggested a role in sepsis for human interleukin for DA1.a cells/leukemia inhibitory factor (HILDA/LIF). HILDA/LIF and interleukin-6 (IL-6) levels were prospectively studied by serial ELISAs in 34 septic patients. HILDA/LIF was detected in 11 of 34 patients at plasma levels of 100-37,000 pg/mL. Peak HILDA/LIF levels correlated with increased temperature and creatinine and IL-6 and with decreased arterial CO2 (P < .05). Multivariate analysis showed that shock and decreased arterial CO2 accounted for 75% of peak HILDA/LIF plasma variations (R2 = .753). Fatal outcome was most often associated with detectable HILDA/LIF (> 56 pg/mL) and peak IL-6 plasma levels > 850 pg/mL (sensitivity, 83%; specificity, 87%), but both (at respective levels of > 480 and > 850 pg/mL) were associated with fatal outcome. HILDA/LIF was detected in septic patients exhibiting shock, and its levels correlated with higher mortality and shorter survival.
    The Journal of Infectious Diseases 02/1995; 171(1):232-6. DOI:10.1093/infdis/171.1.232 · 5.78 Impact Factor
  • P. Le Conte · A. Kenzi · G. Potel · D. Baron · D. Villers · F. Nicolas
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    ABSTRACT: In the last few years, the incidence of severe infection due to Streptococcus A has increased, and the mortality remained high. Fourteen patients with streptococcal A septic shock hospitalized in the Intensive Care Unit between 1983 et 1992 have been included in this study. Clinical, hemodynamic and biological features in survival and non-survival patients have been collected and compared. The Fisher's exact test and the Mann-Whitney test have been performed. Six patients have been admitted in the last two years, demonstrating the increasing frequency of this disease. Six patients died (42 p.100) in an average time of 7 hours after admission. The portal of entry was frequently cutaneous or sub-cutaneous: cellulitis (85 p.100) or wound infection (7,5 p.100). A septic shock was always present. In 7 patients the blood culture grew with Streptococcus A, but the 7 other patients had received antibiotics before the blood sample. All patients received adequate antibiotics, and 8 underwent major surgical procedure. A statistically significant difference was found between the two groups of patients on the following features: arterial bicarbonate and leucocytes count. Septic shocks due to Streptococcus A are often rapidly fatal affections. The incidence of this disease in increasing both in litterature and in our patients. The prognosis factors listed above allow to define a high severity group at risk of early death.
    Réanimation Urgences 01/1995; 4(1). DOI:10.1016/S1164-6756(05)80156-2
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    ABSTRACT: This study was undertaken to evaluate the prescriptions of albumin (a costly product) and plasma (a potentially contaminating product), by the means of an internal medical audit, in one ICU, after a a Consensus development Conference (CC) and to examine if repeating the audit could orientate the practice of the doctors towards a better adequacy to the guidelines defined in the CC statement. The CC tested was the IVth CC organized by the French Language Society of Intensive Care. The criteria to be used to screen the practice and the standards to be met were defined according to the recommendations of the CC. Actual prescribing practice was then screened in the charts of 50 consecutive patients treated for hypovolemia collected during four periods: the first one, one year after the diffusion of the recommendations of the CC, the other ones over the two following years. In the first period, reflecting the intrinsic impact of the CC, only 20,5 p. 100 of the prescriptions of A and 75 p. 100 of the prescriptions of P were adequate to the criteria. Later on, with the repetition of the audit, the adequacy of the prescriptions of P increased to 90 p. 100 in the 2d and 3d periods and decreased to 75 p. 100 in the 4th period when low risk plasma was available; the adequate prescriptions of A rose to 89 p. 100. We conclude that internal audit may be a convenient means to increase the efficiency of a CC.
    Réanimation Urgences 12/1994; 3(5). DOI:10.1016/S1164-6756(05)80757-1
    Réanimation Urgences 01/1994; 3(2). DOI:10.1016/S1164-6756(05)80746-7
    Réanimation Urgences 01/1994; 3(3). DOI:10.1016/S1164-6756(05)80725-X
    Réanimation Urgences 01/1993; 2(6). DOI:10.1016/S1164-6756(05)80341-X
  • F Tasseau · A Chupin · C Pradier · D Villers · D Baron · F Nicolas
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    ABSTRACT: A prospective study was carried out in a medical and surgical ICU to determine the incidence of nosocomial urinary tract infection (NUTI) and to identify the most important risk factors. Over a 6 month period, 180 patients were included. All had an indwelling catheter. Six risk factors were studied: age, sex, illness (medical, surgical, trauma), hospital or extra-hospital origin, simplified acute physiology score and length of bladder catheterization. Forty three patients developed a NUTI. Length of bladder catheterization was the only significant different risk factor in infected and non-infected patients. Kaplan Meir analysis was used to determine time to development of NUTI. The risk rose from 19% for 5 day long catheterization to 50% for 14 day long catheterization.
    Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression 02/1990; 31(8 Spec No):503-4.
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    ABSTRACT: Legionella longbeachae is a new etiologic agent of legionellosis, and sometimes is isolated in environment. We report the first french case of pneumonia due to L. longbeachae serogroup 1, occured in a immunocompromised patient.
    Médecine et Maladies Infectieuses 12/1987; 17(12):736–737. DOI:10.1016/S0399-077X(87)80179-8 · 0.91 Impact Factor
  • Françoise Nicolas · Daniel Villers · Lyliane Rozo · Alain Haloun · Annie Bigot
    Critical Care Medicine 03/1987; 15(2):173-4. DOI:10.1097/00003246-198702000-00021 · 6.15 Impact Factor
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    ABSTRACT: 13 episodes of bacteremia caused by Pasteurella multocida were seen in a general hospital during a 12-year period. All the patients had an underlying disease (77% had cirrhosis) and 2 were receiving chemotherapy for hematologic malignancy. There was a numerical preponderance of male patients (69%). In 5/13 cases a recent animal-derived trauma could be found. In the other cases the source of the infecting organism was thought to be endogenous (from patients' own pharyngeal commensal flora) or secondary to contact with secretions of a pet animal. The clinical presentation of sepsis caused by this organism was nonspecific. Hypotension was seen in 5 cases. Localized sites of infection were certain in 6 and only clinically suspected in 4 other cases. The overall mortality rate was 31%. The administration of ampicillin seems the appropriate therapy for Pasteurella multocida bacteremia.
    Infectious Diseases 02/1987; 19(4):385-93. DOI:10.3109/00365548709021670 · 1.64 Impact Factor
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    ABSTRACT: The influence of patients' age on survival, level of therapy and length of stay was analyzed from data collected in 792 consecutive admissions to eight intensive care units. Mortality rate increased progressively with age; over 65 years of age, it was more than double that of patients under 45 years (36.8% versus 14.8%). However, mortality rate in patients over 75 years was equal to that observed in the 55 to 59 years group. There was a significant relationship between age and acute physiology score (APS) and the influence of age upon outcome decreased when APS increased. The number of TISS (therapeutic intervention scoring system) points delivered to patients increased slightly but significantly with age (r = 0.14). Standard care was responsible for the main part of this increase. Both in survivors and in non-survivors the length of stay was not different comparing the stay of the oldest patient with that of the younger age groups. We conclude that, in ICU patients, age is an important factor of prognosis but not as important as the severity of illness, and that there is no major difference in outcome of patients over 65 years of age compared to the entire study group of ICU patients.
    Intensive Care Medicine 02/1987; 13(1):9-13. DOI:10.1007/BF00263549 · 5.54 Impact Factor
  • O Rodat · J Helias · F Nicolas · G Nicolas
    Acta medicinae legalis et socialis 02/1986; 36(1):67-78.
  • J Hélias · F Daumy · F Nicolas · G Nicolas
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    ABSTRACT: Traumatic myocardial contusion is observed in 15% of autopsy studies; however, it is much more difficult to detect in survivors. Thirty-two consecutive, unselected patients admitted to the intensive care unit for serious thoracic injuries, underwent Th 201 myocardial scintigraphy in 2 to 4 different projections, 2 to 13 days after admission. The results were interpreted double blind and considered positive when a zone of hypofixation creating a defect greater than 25% was observed. The results were correlated with daily ECG recordings, serum CPK MB levels and echocardiography. Thirteen patients (41%) had abnormal scintigraphy. Border line appearances in 1 case excluded any severe myocardial lesions. The other investigations (56%) were normal. These results did not correlate with the ECG or echocardiographic appearances but a significant relationship was found with serum CPK MB levels (p less than 0.05). Therefore, the first investigations did detect cardiac damage but were not specific for myocardial lesions. Thallium 201 myocardial scintigraphy is superior to other non-invasive investigations. It provides information as to the size of the lesion and, by repeated studies, can differentiate simple myocardial contusion from a true traumatic myocardial infarction.
    Archives des maladies du coeur et des vaisseaux 02/1986; 79(1):69-74. · 0.40 Impact Factor
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    ABSTRACT: The reliability of a bronchoscopic protected catheter brush (BPCB) in the diagnosis of lower respiratory tract infection was studied in 17 intubated and ventilated patients, including seven patients free from such infection (group 1) and ten patients with suspected infection (group 2). A first sample was obtained in the lower trachea by aspiration through the fiberoptic bronchoscope and a second in a distal bronchus by the BPCB procedure. In group 1, all BPCB cultures were sterile, although lower tracheal cultures yielded two or more bacterial species, showing that uncontaminated specimens can be obtained by the BPCB procedure. In three patients of group 2, BPCB cultures remained sterile as a nonbacterial pulmonary disease was certified by open lung biopsy. In seven patients from group 2, BPCB cultures yielded all of the organisms isolated simultaneously by reference methods (ie, cultures of blood or pleural fluid, serologic tests, and open lung biopsy). In two of these patients, contamination of the BPCB specimens was ascertained by the reference method bacterial results. In this study the BPCB procedure was able to obtain uncontaminated specimens in intubated and ventilated patients and was mainly accurate in identifying the bacterial etiologic agents of lower respiratory tract infections.
    Chest 11/1985; 88(4):527-30. DOI:10.1378/chest.88.4.527 · 7.13 Impact Factor
  • 01/1985; 1(S1). DOI:10.1017/S1049023X00043764
  • G Potel · F Tasseau · J Calamel · S Louvet · P Desjars · J Ginet · F Nicolas
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    ABSTRACT: The authors present a technique of VO2 and VCO2 measurements by a non invasive method in mechanically ventilated patients. Inspirated and expirated gas are sampled respectively in the inspiratory limb of the patient's breathing circuit and in a mixing chamber. Gas samples are analysed by mass spectrometry in the laboratory. Expiratory flow rate is determined by the ventilator flowmeter. To evaluate this procedure the authors have studied the stability of the inspirated and expirated gas samples and the reproductibility of measurements. In a patient with respiratory and haemodynamic stable status this method measures VO2 within 8,2% and VCO2 within 7%.
    Pathologie Biologie 04/1984; 32(3):209-14. · 1.07 Impact Factor