Fabienne Fieux

Assistance Publique – Hôpitaux de Paris, Lutetia Parisorum, Île-de-France, France

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Publications (48)213.8 Total impact

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    ABSTRACT: Organ donation after unexpected cardiac death (type 2 DCD) is currently authorized in France since 2006. Following the Spanish experience, a national protocol was established to perform liver transplantation from type 2 DCDs. Following declaration of death an Abdominal Normothermic Oxygenated Recirculation (ANOR) was used to perfuse and oxygenate the abdominal organs until harvesting and cold storage. Such grafts were proposed to consenting patients < 65 years old with liver cancer and without any hepatic insufficiency. Between 2010 and 2013, 13 liver transplantations were performed in 3 French centers. Six patients had rapid and uneventful postoperative recovery. However, 3 primary non-functions occurred, each requiring urgent retransplantation and 4 early allograft dysfunctions were observed. One patient developed non-anastomotic biliary stricture after 3 months, while 8 patients showed no sign of ischemic cholangiopathy at their one-year follow up. Compared to a control group of patients receiving grafts from brain dead donors (n=41), donor age and cold ischemic time were significantly lower in the type 2 DCD group. Time spent on the national organ wait list tended to be shorter in the type 2 DCD group (7.5 months [4.0-11.0] vs 12.0 months [6.8-16.7], p=0.08). The one-year patient survival rate was similar (85% in the type 2 DCD group vs. 93% in the control group) but the one-year graft survival rate was significantly lower in the type 2 DCD group (69% vs. 93%, p=0.03). In conclusion, to treat borderline hepatocellular carcinoma, liver transplantation from type 2 DCD donors is possible, provided strict donor selection. This article is protected by copyright. All rights reserved. © 2015 American Association for the Study of Liver Diseases.
    Liver Transplantation 04/2015; DOI:10.1002/lt.24107 · 3.79 Impact Factor
  • 03/2015; 5(2). DOI:10.1007/s13341-014-0498-z
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    ABSTRACT: To assess the first three years of French activity related to liver transplantation from uncontrolled donation after cardiac death (uDCD). Prospective and observational study in the three active centres authorized by the French Biomedicine Agency. All patients deceased between 2010 and 2012 after an uncontrolled cardiac arrest admitted to one of three centres (Pitié-Salpêtrière, Saint-Louis or Bicêtre hospitals, AP-HP, Paris, France) and potentially eligible for liver recovery were included. Abdominal normothermic oxygenated recirculation (ANOR) was used for graft preservation. One hundred twenty-six potential uDCD donors were identified as eligible for liver recovery after hospital admission. The main causes of organ recovery failure were technical failure related to ANOR (29 patients, 23%), refusal of consent (39 patients, 31% of potential uDCD donors and 40% of asked relatives) and abnormal hepatic transaminases up to 200 UI.L(-1) during ANOR (24 patients, 19%). Finally, 11 livers were transplanted. Process efficiency was 9% [95% CI: 4-15%]. One-year recipient survival was 82%, [95% CI: 48-98%] and one-year graft survival was 64% [95% CI: 31-89%]. Liver transplantation from uDCD donors is achievable in France, despite low process efficiency. Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.
    02/2015; 34(1). DOI:10.1016/j.accpm.2014.05.001
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    ABSTRACT: Esophagectomy is the standard of care for high-grade corrosive esophageal necrosis as assessed endoscopically. However, the inaccuracy of endoscopy in determining the depth of intramural necrosis may lead to unnecessary esophageal resection, with devastating consequences. Our aim was to evaluate the use of computed tomography (CT) for the emergency diagnostic workup of endoscopic high-grade corrosive esophageal necrosis.
    Surgical Endoscopy 08/2014; DOI:10.1007/s00464-014-3823-0 · 3.31 Impact Factor
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    ABSTRACT: Existing data suggest that increased interstitial fibrosis may occur abnormally in renal transplants from donations after uncontrolled circulatory death (uDCD).
    Transplantation 06/2014; DOI:10.1097/TP.0000000000000228 · 3.78 Impact Factor
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    ABSTRACT: In the perioperative period, several potential conflicts between anaesthetists/intensive care specialists and surgeons may exist. They are detrimental to the quality of patient care and to the well-being of the teams. They are a source of medical errors and contribute to burn-out. Patients can become the victims of such conflicts, which deserve ethical reflection. Their resolution through analysis and shared solutions is necessary. This article seeks to analyse these conflicts, taking into account their specificities and constraints. In order to understand this context, it is important to consider the specificities of each group involved and the records of such situations. Several factors can prevent these conflicts, first and foremost the patients themselves and the quality of the care that is provided. Medical deontology aims mainly at preventing and resolving these conflicts. Generally speaking, the quality approach which is increasingly applied in health care institutions (involving declarations of adverse events, morbidity/mortality reviews, benchmarking, analysis and improvement of practices, etc.) also contributes to the prevention and resolution of disagreements. The teaching of communication techniques that begins with the initial training, the evaluation of team behaviours (through simulation training for example), the respect of others' constraints, particularly when it comes to learning, as well as transparency regarding conflicts of interests, are all additional elements of conflict prevention. Lastly, conflicts may at times be caused by deviant behaviours, which must be met with a clear and uncompromising collective and institutional approach. This article concludes by offering a standardised approach for conflict resolution.
    Annales francaises d'anesthesie et de reanimation 05/2014; · 0.84 Impact Factor
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    ABSTRACT: In the perioperative period, several potential conflicts between anaesthetists/intensive care specialists and surgeons may exist. They are detrimental to the quality of patient care and to the well-being of the teams. They are a source of medical errors and contribute to burn-out. Patients can become the victims of such conflicts, which deserve ethical reflection. Their resolution through analysis and shared solutions is necessary. This article seeks to analyse these conflicts, taking into account their specificities and constraints. In order to understand this context, it is important to consider the specificities of each group involved and the records of such situations. Several factors can prevent these conflicts, first and foremost the patients themselves and the quality of the care that is provided. Medical deontology aims mainly at preventing and resolving these conflicts. Generally speaking, the quality approach which is increasingly applied in health care institutions (involving declarations of adverse events, morbidity/mortality reviews, benchmarking, analysis and improvement of practices, etc.) also contributes to the prevention and resolution of disagreements. The teaching of communication techniques that begins with the initial training, the evaluation of team behaviours (through simulation training for example), the respect of others’ constraints, particularly when it comes to learning, as well as transparency regarding conflicts of interests, are all additional elements of conflict prevention. Lastly, conflicts may at times be caused by deviant behaviours, which must be met with a clear and uncompromising collective and institutional approach. This article concludes by offering a standardised approach for conflict resolution.
    Annales francaises d'anesthesie et de reanimation 05/2014; DOI:10.1016/j.annfar.2014.04.006 · 0.84 Impact Factor
  • Progrès en Urologie 11/2013; 23(13):1052. DOI:10.1016/j.purol.2013.08.081 · 0.77 Impact Factor
  • Annales Françaises d Anesthésie et de Réanimation 09/2013; 32:A251-A252. DOI:10.1016/j.annfar.2013.07.470 · 0.84 Impact Factor
  • F. Fieux, F. Roussin, L. Jacob
    Annales Françaises d Anesthésie et de Réanimation 09/2013; 32:A252. DOI:10.1016/j.annfar.2013.07.471 · 0.84 Impact Factor
  • Annales Françaises d Anesthésie et de Réanimation 09/2013; 32:A253-A254. DOI:10.1016/j.annfar.2013.07.474 · 0.84 Impact Factor
  • Annales Françaises d Anesthésie et de Réanimation 09/2013; 32:A254. DOI:10.1016/j.annfar.2013.07.475 · 0.84 Impact Factor
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    ABSTRACT: Contexte La prise en charge de la fin de vie constitue un enjeu sociétal crucial auquel le législateur a répondu par la loi du 22 avril 2005. Néanmoins, un débat émerge de la société civile sur l’opportunité de dépénaliser/légaliser l’euthanasie et/ou le suicide assisté (E/SA). Cette question interroge directement les médecins, en particulier les anesthésistes-réanimateurs (AR). Objectif Mettre en perspective les concepts à partir d’une analyse de la littérature médicale et de l’expérience des pays qui ont légiféré sur E/SA. Résultats La loi du 22 avril 2005 constitue une réponse adaptée à l’essentiel des situations de fin de vie auxquelles est confronté l’AR. Sa force tient à l’obligation de dispenser des soins palliatifs quand les thérapeutiques devenues vaines sont interrompues. Néanmoins, les démarches d’accompagnement et de soins palliatifs sont introduites trop tard durant le cours des maladies fatales. Leur enseignement et des mesures incitatives fortes s’imposent. Les rares cas où E/SA sont demandés par les patients ou leurs proches résultent souvent de décisions non prises en amont et/ou de traitements qui ne considèrent pas le patient dans sa globalité. La mise en œuvre d’E/SA ne se résume pas à la simple affirmation d’un principe d’autonomie. Les procédures d’E/SA laissent entrevoir de réelles difficultés et des risques de dérives. Conclusion Nous formulons un message de prudence et de mesure. Peut-on répondre aux questions douloureuses de la fin de vie, de la souffrance morale, en supprimant le sujet lorsqu’une réelle démarche de soins palliatifs n’a pas été pleinement mise en œuvre ?
    Annales francaises d'anesthesie et de reanimation 09/2012; 31(9):694–703. DOI:10.1016/j.annfar.2012.07.019 · 0.84 Impact Factor
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    ABSTRACT: Management of the end of life is a major social issue which was addressed in France by law, on April 22nd 2005. Nevertheless, a debate has emerged within French society about the legalization of euthanasia and/or assisted suicide (E/AS). This issue raises questions for doctors and most especially for anesthetists and intensive care physicians. To highlight, dispassionately and without dogmatism, key points taken from the published literature and the experience of countries which have legislated for E/AS. The current French law addresses most of the end of life issues an intensive care physician might encounter. It is credited for imposing palliative care when therapies have become senseless and are withdrawn. However, this requirement for palliative care is generally applied too late in the course of a fatal illness. There is a great need for more education and stronger incentives for early action in this area. On the rare occasions when E/AS is requested, either by the patient or their loved-ones, it often results from a failure to consider that treatments have become senseless and conflict with patient's best interest. The implementation of E/AS cannot be reduced to a simple affirmation of the Principle of autonomy. Such procedures present genuine difficulties and the risk of drift. We deliver a message of prudence and caution. Should we address painful end of life and moral suffering issues, by suppressing the subject, i.e. ending the patient's life, when comprehensive palliative care has not first been fully granted to all patients in need of it ?
    Annales francaises d'anesthesie et de reanimation 08/2012; 31(9):694-703. · 0.84 Impact Factor
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    ABSTRACT: To investigate the association between severity of acute kidney injury (AKI) and outcome, systemic inflammatory phenotype and HLA genotype in severe sepsis. Prospective multicenter observational study done in 4 intensive care units in two university hospitals. Severe sepsis and septic shock patients with at least 2 organ failures based on the SOFA score were classified: 1) "no AKI", 2) "mild AKI" (grouping stage 1 and 2 of AKIN score) and 3) "severe AKI" (stage 3 of AKIN score). Sequential measurements: The vasopressor dependency index (VDI; dose and types of drugs) to evaluate the association between hemodynamic status and the development of early AKI; plasma levels of IL-10, macrophage migration inhibitory factor (MIF), IL-6 and HLA-DR monocyte expression. Genotyping of the 13 HLA-DRB1 alleles with deduction of presence of HLA-DRB3, -DRB4 and -DRB5 genes. We used multivariate analysis with competitive risk model to study associations. Overall, 176 study patients (146 with septic shock) were classified from AKIN score as "no AKI" (n = 43), "mild AKI" (n = 74) or "severe AKI" (n = 59). The VDI did not differ between groups of AKI. After adjustment, "mild and severe AKI" were an independent risk factor for mortality (HR 2.42 95%CI[1.01-5.83], p = 0.048 and HR 1.99 95%CI[1.30-3.03], p = 0.001 respectively). "Severe AKI" had higher levels of plasma IL-10, MIF and IL-6 compared to "no AKI" and mild AKI (p<0.05 for each), with no difference in mHLA-DR at day 0. HLA-DRB genotyping showed a significantly lower proportion of 4 HLA-DRB alleles among patients requiring renal replacement therapy (RRT) (58%) than in patients with severe AKI who did not receive RRT (84%) (p = 0.004). AKI severity is independently associated with mortality and plasma IL-10, MIF or IL-6 levels. Presence of 4 alleles of HLA-DRB in severe AKI patients seems associated with a lower need of RRT.
    PLoS ONE 06/2012; 7(6):e35838. DOI:10.1371/journal.pone.0035838 · 3.53 Impact Factor
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    ABSTRACT: The ethics committee of the French Society of Anesthesia and Intensive Care (Sfar) has been requested by the French Biomedical Agency to consider the issue of organ donation in patients after a decision of withdrawing life supporting therapies has been taken. This category of organ donation is performed in the USA, Canada, United Kingdom, the Netherlands and Belgium. The three former countries have published recommendations, which formalize procedures and operations. The Sfar ethics committee has considered this issue and envisioned the different aspects of the whole process. Consequently, it sounds a note of caution regarding the applicability of this type of organ procurement in unselected patient following a decision to withdraw life supporting therapies. According to the French regulation concerning organ procurement in brain dead patients, the committee stresses the need to restrict this specific way of procurement to severely brain injured patients, once confirmatory investigations predicting a catastrophic prognosis have been performed. It suggests that the nature of the confirmatory investigation required should be formalized by the French Biomedical Agency on behalf of the French parliamentarians. This should help preserving population trust regarding organ procurement and provide a framework to medical decision. This text has been endorsed by the Sfar.
    Annales francaises d'anesthesie et de reanimation 03/2012; 31(5):454-61. DOI:10.1016/j.annfar.2012.02.009 · 0.84 Impact Factor
  • F. Fieux, L. Jacob
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    ABSTRACT: Dès 2005, face à l’inadéquation persistante entre les indications de greffe et le nombre de greffons disponibles, la France a mis en oeuvre un programme de prélèvements d’organes sur donneurs décédés après arrêt cardiaque (DDAC). Les DDAC regroupent deux entités distinctes: les prélèvements sur donneurs « contrôlés » et « non contrôlés ». Si dans les deux cas le coeur est non battant, les donneurs contrôlés sont des patients hospitalisés en réanimation pour lesquels une décision d’arrêt thérapeutique a été prise (Maastricht III), alors que les seconds sont des donneurs ayant fait un arrêt cardiaque inattendu, le plus souvent en dehors de l’hôpital, et pour lesquels une activité hémodynamique n’a pas pu être restaurée (Maastricht I et II). Si les premiers posent des difficultés éthiques évidentes, les seconds présentent une complexité technique et organisationnelle importante afin de limiter au maximum la durée de l’ischémie chaude. Les prélèvements de reins, de foies et de tissus sur donneurs non contrôlés sont les seuls autorisés en France. Pour minimiser les risques d’échec de greffe, les critères de sélection des donneurs et des receveurs et le respect des délais visant à limiter la durée de l’ischémie chaude sont drastiques. Dans ces conditions, les résultats obtenus sont comparables à ceux des donneurs en état de mal encéphalique.
    Réanimation 01/2012; 22(2). DOI:10.1007/s13546-012-0624-4
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    ABSTRACT: Donation after circulatory determination of death (DCDD), formerly non-heart-beating donation and donation after cardiac death, has been re-introduced into clinical practice in France since June 2006 as a potential solution to organ shortage, but this kidney transplantation programme is not popular yet, mainly because of logistical concerns and uncertainty about the long-term warm ischaemia impact on transplanted kidneys. Our institution started the DCDD programme in January 2007, following the national 'BioMedicine Agency' protocol. We only considered uncontrolled donors with an initial no-flow period (i.e. delay between collapse and external cardiac massage start) <30 min. A 5-min stand-off period was observed before declaring the death and performing in situ cold perfusion, and since January 2010, normothermic subdiaphragmatic extracorporeal membrane oxygenation. All kidneys were machine-perfused using the hypothermic pulsatile preservation system before transplantation. Morphologic assessment and perfusion indexes were used to assess the suitability for transplantation. From January 2007 to December 2010, our team performed 58 kidney transplantations from uncontrolled Maastricht Category I and II donors. Mean recipient age was 47 ± 9 years. Male/female ratio was 45/13. Mean waiting time on transplantation registry was 30 months (4-180). Mean cold ischaemia time was 13 h 40 min (7-18) and pulsatile perfusion time 8 h (1-16). We had three cases (5%) of primary non-function (PNF) and 95% of delayed graft function. There was no increase in biopsy-proven acute rejection incidence (12.7%). Patient and graft survivals were 98 and 91.4%, respectively, at 1 year and 98 and 88%, respectively, at last follow-up. Estimated glomerular filtration rate ( Modification of Diet in Renal Disease formula) was 48 ± 16 mL/min/1.73 m(2) at 1 year and 48 ± 15 mL/min/1.73 m(2) at the last follow-up. DCDD kidneys are a valuable additional source of organs for transplantation. Our results show encouraging outcomes, which give rise to further interest in this donor pool. Respecting the national protocol is crucial to prevent PNF and deleterious warm ischaemia effect on transplanted kidney.
    Nephrology Dialysis Transplantation 12/2011; 27(6):2583-7. DOI:10.1093/ndt/gfr709 · 3.49 Impact Factor
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    ABSTRACT: Expanded criteria donors (ECD) kidneys are a potential solution to organ shortage, but exhibit more delayed graft function (DGF). We conducted a prospective controlled study aiming to evaluate the impact of pulsatile perfusion preservation (PPP) on DGF rate. Inclusion criteria were: 1) ECD definition (any brain-dead donor aged > 60 years or aged 50-60 years with at least 2 of the following: history of hypertension, terminal serum creatinin level = 1.5 mg/dL, death resulting from a cerebrovascular accident; 2) Donor prolonged circulatory arrest (> 20 mn); 3) previsible cold ischemia time longer than 24 hours. In each pair of kidneys, one organ was preserved with PPP and the other organ was preserved in static cold storage. From February 2007 to September 2009, a total of 22 donors (44 recipients) were included. Recipients were comparable in the two groups with respect to demographic and immunological data. The rate of DGF was significantly lower (9% vs. 31.8%, p = 0.021) in the PPP group. At 1, 3, and 12 months, renal function was comparable in the two groups. Pulsatile perfusion preservation significantly reduced DGF rate in ECD kidney transplantation.
    The International journal of artificial organs 06/2011; 34(6):513-8. DOI:10.5301/IJAO.2011.8458 · 1.45 Impact Factor
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    ABSTRACT: Relatives often lack important information about intensive care unit patients. High-quality information is crucial to help relatives overcome the often considerable situational stress and to acquire the ability to participate in the decision-making process, most notably regarding the appropriate level of care. We aimed to develop a list of questions important for relatives of patients in the intensive care unit. This was a multicenter study. Questions asked by relatives of intensive care unit patients were collected from five different sources (literature, panel of 28 intensive care unit nurses and physicians, 1-wk survey of nurses and 1-wk survey of physicians in 14 intensive care units, and in-depth interviews with 14 families). After a qualitative analysis (framework approach and thematic analysis), questions were rated by 22 relatives and 14 intensive care unit physicians, and the ratings were analyzed using principal component analysis and hierarchical clustering. The five sources produced 2,135 questions. Removal of duplicates and redundancies left 443 questions, which were distributed among nine predefined domains using a framework approach ("diagnosis," "treatment," "prognosis," "comfort," "interaction," "communication," "family," "end of life," and "postintensive care unit management"). Thematic analysis in each domain led to the identification of 46 themes, which were reworded as 46 different questions. Ratings by relatives and physicians showed that 21 of these questions were particularly important for relatives of intensive care unit patients. This study increases knowledge about the informational needs of relatives of intensive care unit patients. This list of questions may prove valuable for both relatives and intensive care unit physicians as a tool for improving communication in the intensive care unit.
    Critical care medicine 02/2011; 39(6):1365-71. DOI:10.1097/CCM.0b013e3182120b68 · 6.15 Impact Factor