J F Payen

University Joseph Fourier - Grenoble 1, Grenoble, Rhône-Alpes, France

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Publications (82)154.18 Total impact

  • G. Chanques, S. Jaber, B. Jung, J.-F. Payen
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    ABSTRACT: Le pratiche della sedazione in rianimazione evolvono da diversi anni verso una razionalizzazione della sua somministrazione in un modo quanto più vicino possibile ai bisogni del paziente. Il dolore è, così, valutato e trattato distintamente dal livello di veglia: la sedazione è riformulata in «sedazione-analgesia» (SA). D’altra parte, i lavori intrapresi nell’ultimo decennio hanno mostrato numerosi vantaggi nel ridurre la durata della SA, così come la profondità della sedazione. Diversi concetti di somministrazione consentono di evitare una SA eccessiva e le sue complicanze. Questi concetti sono complementari e non sono contrapposti. Al fine di evitare i sottodosaggi e i sovradosaggi medicamentosi, la SA dovrebbe essere somministrata secondo un algoritmo pilotato dall’equipe infermieristica e che ha come obiettivi dei bersagli di sedazione e di dolore definiti dal medico secondo degli strumenti clinici validi (scala di sedazione, punteggio comportamentale di dolore). La SA profonda dovrebbe essere riservata solo a certi pazienti (distress respiratorio, ipertensione intracranica). In caso di asincronia paziente/ventilatore, il potenziamento della SA dovrebbe avere un ruolo solo dopo aver ottimizzato le impostazioni ventilatorie, privilegiando il concetto dell’adattamento del ventilatore al paziente e non l’inverso. L’indicazione di SA continua dovrebbe essere ricercata quotidianamente e la sua somministrazione dovrebbe essere interrotta al minimo dubbio. Nello stesso senso, alcuni autori hanno anche mostrato che la SA continua non dovrebbe, probabilmente, essere introdotta in tutti i pazienti di rianimazione. Il trattamento puntuale e mirato dei disturbi neurologici e psicologici e del dolore potrebbe rappresentare un’alternativa alla SA continua in un gran numero di pazienti. Infine, nuovi approcci, come la sedazione basata sull’analgesia o su nuovi agenti farmacologici come la dexmedetomidina o i gas alogenati, possono aggiungersi all’insieme di questi concetti complementari.
    EMC - Anestesia-Rianimazione. 01/2014; 19(1):1–12.
  • G. Chanques, S. Jaber, B. Jung, J.-F. Payen
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    ABSTRACT: Las prácticas de la sedación en reanimación han evolucionado desde hace varios años hacia una racionalización de su administración más próxima a las necesidades del paciente. De este modo, el dolor se evalúa y se trata con independencia del nivel de vigilancia: la sedación se ha convertido en «sedación-analgesia» (SA). Por otra parte, los trabajos realizados en la última década han demostrado que la disminución de la duración de la SA y de la profundidad de la sedación tiene muchas ventajas. Varios conceptos de administración permiten evitar una SA excesiva y sus complicaciones. Estos conceptos son complementarios y no opuestos. Para evitar las infradosificaciones y sobredosis farmacológicas, la SA debería administrarse siguiendo un algoritmo dirigido por el equipo de enfermería y cuyos objetivos estén dirigidos a la sedación y el dolor, prescritos por el médico según unas herramientas clínicas validadas (escala de sedación, escala conductual de dolor). La SA profunda sólo debería reservarse a algunos pacientes (dificultad respiratoria, hipertensión intracraneal). En caso de asincronía paciente/ventilador, el refuerzo de la SA sólo debería emplearse después de haber optimizado los ajustes ventilatorios, dando prioridad al concepto de adaptación del ventilador al paciente y no a la inversa. La indicación de SA continua debería evaluarse a diario y su administración debería interrumpirse ante la mínima duda. En este mismo sentido, algunos autores han mostrado incluso que la SA continua probablemente no debería introducirse en todos los pacientes de reanimación. El tratamiento puntual y dirigido de los trastornos neurológicos y psicológicos, así como del dolor, podría constituir una alternativa a la SA continua en un gran número de pacientes. Por último, hay nuevas estrategias, como la sedación basada en la analgesia o en nuevos fármacos como la dexmedetomidina o los gases halogenados, que pueden añadirse al conjunto de estos conceptos complementarios.
    EMC - Anestesia-Reanimación. 01/2014; 40(1):1–13.
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    ABSTRACT: Survival after severe trauma may depend on a structured chain of care from the management at the scene of trauma to hospital care and rehabilitation. In the USA, the trauma system is organized according to a pre-hospital triage by paramedics to facilitate the admission of patients to tertiary trauma centres. In France, trauma patients are transported to the most suitable facility, according to the on-scene triage by an emergency physician. Because French hospital's resources become scarce and expensive, the access to all techniques of resuscitation after severe trauma is restricted to tertiary trauma centres, at the expense of prolonged duration of transfer to these centres with a possible impact on mortality. The Northern French Alps Emergency Network created a regional trauma network system in 2008. This organization was based upon the interplay between the resources of each hospital participating to the network and the categorization of trauma severity at the scene. A regional registry allows the assessment of trauma system, which has included 3,690 severe trauma patients within the past 3years. Bystanders, medical call dispatch centres, and interdisciplinary trauma team should form a structured and continuous chain of care to allocate each severe trauma patient to the best place of treatment.
    Annales francaises d'anesthesie et de reanimation 07/2013; · 0.77 Impact Factor
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    ABSTRACT: Aim To evaluate the impact of a regional trauma network on intra-hospital mortality rates of patients admitted with severe pelvic trauma. Study Retrospective observational study. Patients Sixty-five trauma patients with serious pelvic fracture (pelvic abbreviated injury scale [AIS] score of 3 or more). Methods Demographic, physiologic and biological parameters were recorded. Observed mortality rates were compared to predicted mortality according to the Trauma Revised Injury Severity Score methodology adjusted by a case mix variation model. Results Twenty-nine patients were admitted in a level I trauma centre (reference centre) and 36 in level II trauma centres (centres with interventional radiology facility and/or neurosurgery). Patients from the level I trauma centre were more severely injured than those who were admitted at the level II trauma centres (Injury Severity Score [ISS]: 30 [13–75] vs 22 [9–59]; P < 0.01). Time from trauma to hospital admission was also longer in level I trauma centre (115 [50–290] min vs 90 [28–240] min, P < 0.01). Observed mortality rates (14%; 95% confidence interval, 95% CI, [1–26%]) were lower than the predicted mortality (29%; 95% CI [13–44%]) in the level I trauma centre. No difference in mortality rates was found in the level II trauma centres. Conclusion The regional trauma network could screen the most severely injured patients with pelvic trauma to admit them at a level I trauma centre. The observed mortality of these patients was lower than the predicted mortality despite increased time from trauma to admission.
    Annales francaises d'anesthesie et de reanimation 01/2013; · 0.77 Impact Factor
  • P. Bouzat, G. Francony, M. Oddo, J.-F. Payen
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    ABSTRACT: Therapeutic hypothermia (TH) is considered a standard of care in the post-resuscitation phase of cardiac arrest. In experimental models of traumatic brain injury (TBI), TH was found to have neuroprotective properties. However, TH failed to demonstrate beneficial effects on neurological outcome in patients with TBI. The absence of benefits of TH uniformly applied in TBI patients should not question the use of TH as a second-tier therapy to treat elevated intracranial pressure. The management of all the practical aspects of TH is a key factor to avoid side effects and to optimize the potential benefit of TH in the treatment of intracranial hypertension. Induction of TH can be achieved with external surface cooling or with intra-vascular devices. The therapeutic target should be set at a 35 °C using brain temperature as reference, and should be maintained at least during 48 hours and ideally over the entire period of elevated intracranial pressure. The control of the rewarming phase is crucial to avoid temperature overshooting and should not exceed 1 °C/day. Besides its use in the management of intracranial hypertension, therapeutic cooling is also essential to treat hyperthermia in brain-injured patients. In this review, we will discuss the benefit-risk balance and practical aspects of therapeutic temperature management in TBI patients.
    Annales francaises d'anesthesie et de reanimation 01/2013; 32(11):787–791. · 0.77 Impact Factor
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    ABSTRACT: Background Assess efficacy, satisfaction and usefulness of an educational maze based on posters and audioguide for major trauma care teaching to medical students. The educational maze consists of posters with audio comments recorded in an audioguide. This tool was part of a larger educational program including medical simulation.Study designProspective, interventional, observational, monocentric study.StudentMedical student of Grenoble University Hospital, in the four last years of medical school, following a training course in anesthesia, emergency medical services and intensive care units.Method Forty essentials key messages for major trauma management were included in 10 posters and audioguides. A first assessment with short opened answers was handed to the students at the end of the educational maze to assess their memorization. A second assessment with simple choice answers regarding satisfaction and usefulness of this new educational tool was realized at the end of the entire program.ResultOne hundred and eighty-four medical students attending the major trauma program were included in this study. On the first test, 75% of essential knowledge on major trauma management was memorized by more than 50% of the medical students. On the second test, 94% of medical students had a high satisfaction level of this educational maze.Conclusion An educational maze based on posters and audioguides seems to be an efficient, useful tool for teaching essential knowledge on major trauma management to medical students.
    Annales francaises d'anesthesie et de reanimation 11/2012; 31(11):857–862. · 0.77 Impact Factor
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    ABSTRACT: Rehabilitation improves the functional prognosis of patients after a neurologic lesion, and tendency is to begin rehabilitation as soon as possible. This review focuses on the interest and the feasibility of very early rehabilitation, initiated from critical care units. It is necessary to precisely assess patients’ impairments and disabilities in order to define rehabilitation objectives. Valid and simple tools must support this evaluation. Rehabilitation will be directed to preventing decubitus complications and active rehabilitation. The sooner rehabilitation is started; the better functional prognosis seems to be.
    Annales francaises d'anesthesie et de reanimation 10/2012; 31(10):e253–e263. · 0.77 Impact Factor
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    ABSTRACT: Automated assessment of circulatory response to surgical stimuli is unsolved. Would detection of cardiac baroreflex inhibition assess adequacy of intra-operative anti-nociception upon incision, as performed on-line on a beat-by-beat basis by a cardiovascular index, CARDEAN™? 18 ASA I-II patients undergoing spinal disc repair were studied, in a prospective randomized single-blinded trial (observational study). During infusion of propofol to maintain bispectral index between 40 and 60, patients were allocated to receive an effect site target-controlled infusion of remifentanil at Ce = 2 or 4 ng ml(-1). Upon incision and during surgery, circulatory response was assessed using beat-by-beat measurements of minor hypertension and tachycardia to give a cardiovascular index, CARDEAN, scaled between 0 and 100. Upon skin incision, CARDEAN increased in the remifentanil Ce = 2 ng ml(-1) group (n = 7, P < 0.05), while it did not increase in the remifentanil Ce = 4 ng ml(-1) group (n = 7, P = 0.18). During surgery, retrospectively, CARDEAN > 60 was associated with tachycardia and hypertension (P (k) = 0.81 ± 0.10). Changes in CARDEAN appeared linked to adequacy of anti-nociception.
    International Journal of Clinical Monitoring and Computing 06/2012;
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    ABSTRACT: Pupil size reflects the balance between sympathetic and parasympathetic systems. Due to technological advances, accurate and repeated pupil size measurements are possible using infrared, video-recorded pupillometers. Two pupil size reflexes are assessed: the pupillary reflex dilation during noxious stimulation, and the pupil light reflex when the pupil is exposed to the light. The pupillary reflex dilation estimates the level of analgesia in response to a painful procedure or to a calibrated noxious stimulus, i.e., tetanic stimulus, in nonverbal patients. This might be of particular interest in optimizing the management of opioids in anaesthetized patients and in assessing pain levels in the intensive care unit. The pupil light reflex measurement is part of the routine monitoring for severely head-injured patients. The impact of pupillometry in this condition remains to be determined.
    Annales francaises d'anesthesie et de reanimation 06/2012; 31(6):e155–e159. · 0.77 Impact Factor
  • G. Francony, P. Bouzat, J.-F. Payen
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    ABSTRACT: Near infrared spectroscopy (NIRS) can noninvasively measure cerebral saturation in oxygen, that permits to estimate brain oxygenation and metabolism. This technique could be incorporated into a multimodal monitoring for severely brain-injured patients. This review presents the principles of NIRS, its limits, the main results from clinical studies and its perspectives. More clinical studies are needed before recommending the routine use of NIRS in the ICU.
    Annales francaises d'anesthesie et de reanimation 06/2012; 31(6):e133–e136. · 0.77 Impact Factor
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    ABSTRACT: Cerebral ischaemia plays a major role in the outcome of brain-injured patients. Because brain oxygenation can be assessed at bedside using intra-parenchymal devices, there has been a growing interest about whether therapeutic hyperoxia could be beneficial for severely head-injured patients. Normobaric hyperoxia increases brain oxygenation and may improve glucose-lactate metabolism in brain regions at risk for ischaemia. However, benefits of normobaric hyperoxia on neurological outcome are not established yet, that hinders the systematic use of therapeutic hyperoxia in head-injured patients. This therapeutic option might be proposed when brain ischemia persists despite the optimization of cerebral blood flow and arterial oxygen blood content.
    Annales francaises d'anesthesie et de reanimation 03/2012; 31(3):224–227. · 0.77 Impact Factor
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    ABSTRACT: Cerebral amyloid angiopathy is a common cause of intracerebral haemorrhage in elderly patients. The diagnosis of cerebral amyloid angiopathy is based on the Boston criteria combining clinical and radiological criteria with no other cause of intracerebral haemorrhage. We describe the case of a 60-year-old female admitted to the intensive care unit for agitation and spatial disorientation. She had multiple intracerebral haematomas on brain CT scan. Typical cerebral microbleeds using MRI and the absence of other cause of intracerebral haemorrhage argued in favour of the diagnosis of cerebral amyloid angiopathy. The patient outcome was favourable with a discharge from the intensive care unit on day 16.
    Annales Francaises D Anesthesie Et De Reanimation - ANN FR ANESTH REANIM. 12/2011;
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    ABSTRACT: Le traitement de la douleur en réanimation est distincte de la sédation ou baisse de la vigilance. La sédation et l’analgésie ne doivent être ni insuffisantes — car elles ne permettent pas le contrôle de la douleur et de l’agitation —, ni excessives — car elles peuvent conduire à l’allongement de la durée de séjour et à un surcoût économique. L’efort actuel doit porter sur le maintien à un niveau le plus faible possible de la sédation pharmacologique (hypnotiques), sur l’évaluation et le traitement de la douleur adaptés aux soins douloureux, et sur l’utilisation de protocoles écrits pour la gestion quotidienne de la sédation et de l’analgésie en réanimation.
    01/2011: pages 13-21;
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    ABSTRACT: Objectives The main objective was to estimate the nature, severity and medical care of severe trauma injuries following mountain activities as compared to severe trauma following traffic accident in a mountain area.
    Annales Francaises D Anesthesie Et De Reanimation - ANN FR ANESTH REANIM. 01/2011; 30(10):730-733.
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    ABSTRACT: From prehospital management through tertiary hospital care and rehabilitation, many facilities and medical specialities have an influence on injured patient's mortality. Anglo-saxon countries implemented regional trauma network “Trauma system” which organized prehospital trauma triage to tertiary trauma centres. In France, injured patients are transported to the closest and most appropriate facility according to the on-scene triage done by an emergency physician. Faced with the development of new techniques in trauma care, many facilities cannot provide definitive care and inappropriate patient triage will increase prehospital transfer time. A regional trauma network is essential to organize the initial prehospital triage and shared the medical resources. Since 2008, the Northern French Alps Emergency Network created with the Alps trauma centre of Grenoble University Hospital, a trauma system with emergency physicians, anaesthesiologists, radiologists and surgeons from three departments which combined the particularities of the French emergency medical service and regional network. The quality management of this unique experience in France is evaluated by a trauma registry. Network and audit are essential to improve the quality of care. Bystander witnesses, medical call dispatch center, emergency physicians, anaesthesiologists, radiologists and surgeons set up a survival chain.
    Cognition 11/2010; · 3.16 Impact Factor
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    ABSTRACT: Obstructive sleep apnoea (OSA) syndrome in adult is defined as an Apnoea-Hypopnoea Index (AHI) of 5 or more per hour of sleep in a context of excessive daytime sleepiness and snoring. OSA is considered as mild with an AHI of 5–15, moderate with an AHI of 15–30, and severe with an AHI greater than 30. OSA is a highly prevalent disease since it should affect 7–15% of the middle-aged population, but most patients are not yet diagnosed for OSA. Middle age, male gender, obesity and arterial hypertension are main risk factors for OSA in adults. OSA patients are exposed to higher neurological and cardiovascular morbidity, including stroke, depression, hypertension, coronary artery disease, heart failure, arrhythmias. Because OSA may lead to life-threatening problems if undiagnosed, anaesthesiologists should be aware of their screening role in the preoperative period. In that way, the STOP-BANG questionnaire is a well-adapted instrument to screen patients for OSA during the preoperative visit. OSA patients are exposed to higher preoperative morbidity in relation with OSA severity, particularly difficult manual ventilation with mask, difficult tracheal intubation and postoperative upper airway obstruction. The unknown diagnosis of OSA is one major contributor to facilitate the occurrence of those events. In the postoperative period, early resuming continuous positive airway pressure and installing the OSA patient in a nonsupine position could be effective in preventing pharyngeal obstruction. Considering the timing of postoperative complications, a careful monitoring in the post-anesthesia care unit for three hours is an appropriate strategy for a majority of OSA patients. Alternatives to opioids should be promoted for postoperative pain control.
    Annales francaises d'anesthesie et de reanimation 11/2010; 29(11):787–792. · 0.77 Impact Factor
  • Revue Des Maladies Respiratoires - REV MAL RESPIR. 01/2010; 27.
  • Revue D Epidemiologie Et De Sante Publique - REV EPIDEMIOL SANTE PUBL. 01/2009; 57.
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    ABSTRACT: The objectives for using sedation in neurointensive care unit (neuroICU) are somewhat different from those used for patients without severe brain injuries. One goal is to clinically reassess the neurological function following the initial brain insult in order to define subsequent strategies for diagnosis and treatment. Another goal is to prevent severely injured brain from additional aggravation of cerebral blood perfusion and intracranial pressure. Depending on these situations is the choice of sedatives and analgesics: short-term agents, e.g., remifentanil, if a timely neurological reassessment is required, long-term agents, e.g., midazolam and sufentanil, as part of the treatment for elevated intracranial pressure. In that situation, a multimodal monitoring is needed to overcome the lack of clinical monitoring, including repeated measurements of intracranial pressure, blood flow velocities (transcranial Doppler), cerebral oxygenation (brain tissue oxygen tension), and brain imaging. The ultimate stop of neurosedation can distinguish between no consciousness and an alteration of arousing in brain-injured patients. During this period, an elevation of intracranial pressure is usual, and should not always result in reintroducing the neurosedation.
    Annales Francaises D Anesthesie Et De Reanimation - ANN FR ANESTH REANIM. 01/2009; 28(12):1015-1019.
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    ABSTRACT: Therapeutic hypothermia (less than 35°C) is a promising strategy to improve neuroprotection after severe brain injury. Except in patients resuscitated from cardiac arrest, its effectiveness has not yet been demonstrated. Therapeutic hypothermia results in various side effects, including cardiovascular, hydroelectrolytic and infectious disorders, which could explain, in part, the lack of conclusive clinical studies. These hazards are associated with practical difficulties to induce and maintain targeted hypothermia and with rewarming management. An improvement in the techniques for achieving targeted hypothermia, more knowledge about side effects and further randomized clinical trials are needed before recommending the use of therapeutic hypothermia for patients with severe traumatic brain injury.
    Annales Francaises D Anesthesie Et De Reanimation - ANN FR ANESTH REANIM. 01/2009; 28(4):371-374.