Armelle Nicolas-Robin

Armelle Nicolas-Robin
Assistance Publique – Hôpitaux de Paris | AP-HP · Département de Médecine Palliative pédiatrique

MD, PhD Intensivist and palliative medicine and medical ethics

About

64
Publications
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Publications

Publications (64)
Article
Full-text available
A correction to this paper has been published: https://doi.org/https://doi.org/10.1007/s00431-021-04026-x
Article
During the first Covid-19 wave, our paediatric intensive care unit (PICU), like many others across the globe, was transformed into an adult ICU for patients with severe Covid-19, due to a shortage of adult ICU beds. Here, we provide a comprehensive description of all the conditions that must be fulfilled to successfully accomplish this transformati...
Thesis
La transplantation d'un organe peut s’avérer être le traitement de dernier recours en cas de dysfonctionnement terminal. Mais le nombre de greffons proposés à la transplantation ne suffit pas à satisfaire le nombre croissant de demandes. Des solutions alternatives sont proposées pour tenter de réduire cet écart. Certaines d'entre elles peuvent heur...
Article
Résumé L’acharnement thérapeutique, défini par la mise en route ou la poursuite d’un traitement déraisonnable, est assimilé à un acte malveillant moralement condamnable. La loi no 2005-370 du 22 avril 2005 relative aux droits des malades et à la fin de vie l’a rendu illégal. Lorsque le patient informé n’est plus compétent pour d’exprimer ses préfér...
Article
Full-text available
Ce document fait le point sur la littérature scientifique concernant les directives anticipées (DA). Il reflète également l’analyse du comité éthique de la Sfar. Les éléments singuliers des expériences étrangères sont décrits en regard de la situation française. Leurs forces et limites sont analysées. Les DA permettent une réelle expression de l’au...
Article
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 t...
Article
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 th...
Article
Delayed graft function is a major determinant of long-term renal allograft survival. Despite considerable efforts to improve donor selection and matching, incidence of delayed graft function remains close to 25%. As neutrophil gelatinase-associated lipocalin (NGAL) has been shown to predict acute renal failure, the authors tested the hypothesis tha...
Article
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 eth...
Article
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 eth...
Article
Full-text available
/st>Post-anaesthesia care units (PACUs) with 24/7 activity and consequently artificial light and noise may disturb the sleep of patients who require prolonged medical supervision. After one postoperative night, we compared sleep quality in patients with and without noise (earplug) and light (eye mask) protection. /st>After ethical board approval, 4...
Article
Purpose of review: The purpose of the present review is to describe the methods using an extracorporeal membranous oxygenation (ECMO) circuit in donors after cardiac death and to evaluate their impact on the outcome of renal transplantation. Recent findings: ECMO can be used either in hypothermic conditions for total body cooling or in normother...
Article
Full-text available
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 a...
Article
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 h...
Article
Full-text available
Introduction Many potential lung transplants are lost because of hypoxemia during donor management. We hypothesized that the apnea test, necessary to confirm the diagnosis of brain death in potential lung donors, was involved in the decrease in the ratio of partial pressure of arterial O2 to fraction of inspired O2 (PaO2/FiO2) and that a single rec...
Article
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 Nethe...
Article
Organ donation after cardiac death has been used for kidney and liver procurement in France since 2006. Until recently, most teams relied on in situ cold perfusion to prepare the donor before organ retrieval. Our team has used since 2007 normothermic abdominal recirculation. While this technique is presumed to be more difficult to implement, it als...
Article
After brain death, adrenal insufficiency (AI) is very common and may be one of the mechanisms that contributes to hemodynamic instability and loss of potential organ donors. However, when diagnosed by total cortisol measurement, critically ill patients may be overdiagnosed as having AI. The aims of this study were to assess the prevalence of AI whe...
Article
Full-text available
Severe postpartum haemorrhage (SPPH) is the leading cause of peripartum hysterectomy and maternal death. There are no easily measurable parameters that indicate the failure of medical therapy and the need for an advanced interventional procedure (AIP) to stop genital tract bleeding. The aim of the study was to define factors predictive of the need...
Data
Algorithm used to decide whether extracorporeal life (ECL) support in treating patients in refractory cardiac arrest (CA) is indicated. From Riou et al. [28]. CPR, cardiopulmonary resuscitation; VT, ventricular tachycardia; VF, ventricular fibrillation; TP, torsades de pointes; ETCO2, end tidal CO2 (measured 20 minutes after the onset of medical CP...
Article
Full-text available
Extracorporeal life support (ECLS) has recently shown encouraging results in the resuscitation of in-hospital (IH) refractory cardiac arrest. We assessed the use of ECLS following out-of-hospital (OH) refractory cardiac arrest. We evaluated 51 consecutive patients who experienced witnessed OH refractory cardiac arrest and received automated chest c...
Article
Full-text available
Hemodynamic instability is frequent in brain-dead patients and may result, in part, from absolute or relative adrenal insufficiency. Corticosteroid supplementation is widely used to restore hemodynamic stability in septic shock and to reduce the time of shock resolution. The authors verified that supplementation with hydrocortisone may enhance hemo...
Article
Full-text available
Single-use metal laryngoscope blades are cheaper and carry a lower risk of infection than reusable metal blades. The authors compared single-use and reusable metal blades during rapid sequence induction of anesthesia in a multicenter cluster randomized trial. One thousand seventy-two adult patients undergoing general anesthesia under emergency cond...
Article
Whether cardiac ventricles can acutely dilate during septic myocardial dysfunction. A prospective echocardiographic study was performed to assess changes of left ventricular dimensions over time in patients with septic shock. A 20-bed surgical intensive care unit of Pitié-Salpêtrière university hospital in Paris. Forty-five patients were studied ov...
Chapter
Aujourd’hui, en France, trois circons tances peuvent donner lieu à un prélèvement d’organes : le prélèvement sur donneur vivant ; le prélèvement sur donneur décédé après arrêt cardiaque et le prélèvement sur donneur décédé en mort encéphalique. Les donneurs d’organes issus de cette dernière catégorie représentaient 85 % des donneurs d’organes en 20...
Article
As a result of donor heart shortage, resorting to marginal heart donors is being promoted. Dobutamine is usually used to support these potential donors and has been proposed to identify the reversible part of the brain death-induced myocardial dysfunction before potential organ donation. But dobutamine impairs the oxygen supply-demand balance and m...
Article
Many patients with septic shock and increased cardiac troponin I (cTnI) do not exhibit significant left ventricular systolic dysfunction. We hypothesized that an isolated and reversible impairment of ventricular relaxation may be associated with the increase in cTnI. Prospective, observational study. Surgical intensive care unit in a university hos...
Article
Diagnosis of brain death usually requires the absence of spontaneous respiratory movements during the apnoea test and an arterial carbon dioxide partial pressure above 60 mmHg. On the other hand, although capnography (end-tidal CO(2)) is currently monitored in intensive care unit patients, it has not been evaluated during the apnoea test in brain-d...
Article
Brain death may induce cardiac dysfunction. In potential organ donors measurements of N-terminal pro-brain natriuretic peptide (NT-proBNP) and circulating cardiac troponins T and I (cTnT and cTnI), alone or in combination, are performed to investigate the accuracy of these biomarkers for early diagnosis of left ventricular systolic dysfunction. Pro...
Article
Plastic single-use laryngoscope blades are inexpensive and carry a lower risk of infection compared with metal reusable blades, but their efficiency during rapid sequence induction remains a matter of debate. The authors therefore compared plastic and metal blades during rapid sequence induction in a prospective randomized trial. Two hundred eighty...
Article
In cardiac patients, pulmonary capillary wedge pressure (PCWP) is estimated using color M-mode Doppler study of left ventricular filling and Doppler tissue imaging. The goal of this study was to assess whether echocardiography accurately estimates PCWP in critically ill patients. Sixty ventilated patients admitted for septic shock and acute lung in...
Article
Full-text available
Lung tissue deposition and antibacterial efficiency of nebulized and intravenous amikacin (AMK) were compared in anesthetized and ventilated piglets suffering from a bronchopneumonia produced by the intrabronchial inoculation of Escherichia coli. AMK was administered 24 hours after the inoculation either through an ultrasonic nebulizer (45 mg x kg-...
Article
The use of human recombinant CuZn superoxide dismutase (rhSOD) in addition to exogenous surfactant has been studied as a therapeutic strategy to prevent acute and chronic lung injury in premature infants with blood monocytes (MO). However, scavenging of superoxide by rhSOD may compromise bacterial killing by phagocytes. In the present study, we inv...
Article
In the current study, the use of a target-controlled infusion of low-dose propofol was combined with a continuous infusion of sufentanil for patients undergoing mitral valve surgery. The purpose of the study was to evaluate the hemodynamic stability, the time to awakening and spontaneous ventilation, and the feasibility in an early extubation setti...
Article
The fundamental property of blood substitutes is the ability to transport and deliver oxygen and carbon dioxide. Hemoglobin-based solutions and fluorocarbons are currently under clinical investigation. Hemoglobin solutions are produced from different sources with various difficulties. The major sources of hemoglobin solutions available today are hu...

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