Benoit Vallet

• Centre Hospitalier Régional Universitaire de Lille

Objective To investigate maternal and neonatal outcomes after a delivery in France in 2019, according to hospital characteristics and the impact of distance and time of travel on mother and newborn. Methods All parturients above 18 years of age who delivered in 2019 and were identified in the French health insurance database were included, with th...

Background Hip arthroplasty is a frequently performed procedure in orthopedic surgery, carried out in almost all health structures for two main issues: fracture and coxarthrosis. Even if volume–outcome relationship appeared associated in many surgeries recently, data provided are not sufficient to set surgical thresholds neither than closing down l...

This paper describes the development and implementation of an anesthesia data warehouse in the Lille University Hospital. We share the lessons learned from a ten-year project and provide guidance for the implementation of such a project. Our clinical data warehouse is mainly fed with data collected by the anesthesia information management system an...

Introduction Many recent studies have investigated the hospital volume-outcome relationship in surgery. In some cases, the results have prompted the centralization of surgical activity. However, the methodologies and interpretations differ markedly from one study to another. The objective of the present scoping review was to describe the various fe...

The purpose of the study was to evaluate the behavior of the venous-to-arterial CO 2 tension difference (ΔPCO 2 ) over the arterial-to-venous oxygen content difference (ΔO 2 ) ratio (ΔPCO 2 /ΔO 2 ) and the difference between venous-to-arterial CO 2 content calculated with the Douglas’ equation (ΔCCO 2D ) over ΔO 2 ratio (ΔCCO 2D /ΔO 2 ) and their a...

Background: Students' choice of medical specialties has evolved throughout year, with a growing interest in quality of life and in technological specialties. We investigated the repartition of such choices in the world and its influencing factors with a focus on the gender's influence, for helping policy-makers to deal with medical shortage and te...

Introduction: Even if a positive volume-outcome correlation in surgery is mostly admitted in many surgical fields, the various ways to assess this relationship make it difficult for researchers and policymakers to use it. Our aim is therefore to provide an overview of the way hospital volume-outcome relationship was assessed. Through this overview,...

Background: Rapid identification and treatment of tissue hypoxia reaching anaerobiosis (dysoxia) may reduce organ failure and the occurrence of major postoperative complications (MPC) after cardiac surgery. The predictive ability of PCO2-based dysoxia biomarkers, central venous-to-arterial PCO2 difference (ΔPCO2) and ΔPCO2 to arteriovenous oxygen...

In critically ill patients, tissue hypoperfusion is an important cause leading to multi-organ dysfunction and death, and it cannot always be detected by measuring standard global hemodynamic and oxygen-derived parameters. Gastric intramucosal PCO2 as measured by gastric tonometry has been recognized to be of clinical value as a prognostic factor, i...

In critically ill patients, tissue hypoperfusion is an important cause leading to multi- organ dysfunction and death, and it cannot always be detected by measuring standard global hemodynamic and oxygen-derived parameters. Gastric intramucosal PCO2 as measured by gastric tonometry has been recognized to be of clinical value as a prognostic factor,...

Background: To evaluate the ability of the central venous-to-arterial CO2 content and tension differences to arteriovenous oxygen content difference ratios (∆ContCO2/∆ContO2 and ∆PCO2/∆ContO2, respectively), blood lactate concentration, and central venous oxygen saturation (ScvO2) to detect the presence of global anaerobic metabolism through the i...

Introduction L’hypertension artérielle, la dysfonction endothéliale et l’activation de la coagulation décrites dans la pré-éclampsie (PE) auraient un impact sur le débit cardiaque (DC) et l’hémodynamique microcirculatoire. Peu de travaux comparatifs ont évalué ces paramètres dans la pré-éclampsie. L’objectif de cette étude est de déterminer si la p...

Introduction La transfusion de concentrés de globules rouges (CGR) est un acte fréquent en périopératoire. Une stratégie basée sur un taux d’hémoglobine (Hb) est recommandée d’après la XXXIIIe conférence de consensus de la Société française d’anesthésie-réanimation (SFAR) de 2003. L’hémoglobine est un élément essentiel de l’adéquation transport/con...

Introduction Les critères décisionnels pour la réadministration de sufentanil au cours de l’anesthésie générale reposent sur l’augmentation de fréquence cardiaque (FC) ou de la pression artérielle systolique (PAS), mais peuvent également intégrer des données issues du monitorage du système nerveux autonome telles que l’Analgesia Nociception Index (...

Introduction L’induction de l’anesthésie générale entraîne fréquemment une hypotension (hypoTA) dans les minutes suivant l’administration des médicaments anti-nociceptifs et hypnotiques. Si les mécanismes responsables de l’hypoTA sont connus, la fréquence réelle, dans la pratique quotidienne, de ce phénomène est peu documentée. L’objectif de cette...

Evidence suggests that sleep deprivation associated with night-time working may adversely affect performance resulting in a reduction in the safety of surgery and anaesthesia. Our primary objective was to evaluate an association between nonelective night-time surgery and in-hospital mortality. We hypothesised that urgent surgery performed during th...

The purpose of this study was to evaluate the clinical relevance of high values of central venous-to-arterial carbon dioxide difference (PCO2 gap) in high risk surgical patients admitted in postoperative intensive care unit (ICU). We hypothesized that PCO2 gap could serve as a useful tool to identify patients still requiring hemodynamic optimizatio...

AIMS are optimized to find and display data and curves about one specific intervention but is not retrospective analysis on a huge volume of interventions. Such a system present two main limitation; (1) the transactional database architecture, (2) the completeness of documentation. In order to solve the architectural problem, data warehouses were d...

Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide. Recent advances in the management of severe bleeding for trauma patients may provide insight into PPH management, but must be applied with caution considering the significant differences between trauma and obstetric patients. In this review, we summarized evidence for c...

Cardiomyocyte calcium homeostasia is essential to cardiomyocyte excitation and contraction. Calcium enters through voltage-dependant calcium channels (ICal) and activates sarcoplasmic reticulum (SR) membrane ryanodine receptors (RyRs) triggering a massive release of stored Ca2+ essential to actine-myosine cross-bridging and sarcomere shortening. Ca...

Central venous-to-arterial carbon dioxide partial pressure difference (ΔPCO2) can be used as a marker for the efficacy of venous blood in removing the total CO2 produced by the tissues. To date, this role of ΔPCO2 has been assessed only in patients after resuscitation from septic shock with already normalised central venous oxygen saturation (ScvO2...

To assess the time course of the central venous-arterial carbon dioxide tension difference (∆PCO2)-as an index of the carbon dioxide production (VCO2)/cardiac index (CI) ratio-in stable septic shock patients receiving incremental doses of dobutamine. Twenty-two hemodynamically stable septic shock patients with no signs of global tissue hypoxia, as...

Hospital information system manages patient's hospitalization information across different applications and databases. As statistics are performed with difficulties on these different databases, the university hospital of Lille developed an anesthesia data warehouse. This common structure stores data related to anesthesia procedures and patient hos...

Determining the venous-to-arterial PCO2 difference (PCO2gap) during resuscitation of septic shock patients might be useful when deciding when to continue resuscitation despite a ScvO2 >70% associated with hyperlacticemia. Because hyperlacticemia is not a discriminatory factor in defining the cause of that stress, a PCO2gap >6 mmHg could be used to...

Background: Cardiac output (CO) is rarely monitored during surgery, and arterial pressure remains the only hemodynamic parameter for assessing the effects of volume expansion (VE). However, whether VE-induced changes in arterial pressure accurately reflect changes in CO has not been demonstrated. The authors studied the ability of VE-induced chang...

Background Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfi rmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after no...

Background Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfi rmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after no...

Background Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after no...

Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac su...

In critical care, the monitoring is essential to the daily care of ICU patients, as the optimization of patient's hemodynamic, ventilation, temperature, nutrition, and metabolism is the key to improve patients' survival. Indeed, the decisive endpoint is the supply of oxygen to tissues according to their metabolic needs in order to fuel mitochondria...

Background: The aim of this paper was to clarify if previously established prognostic factors explain the different mortality rates observed in ICU septic patients around the world. Methods: This is a sub-study from the PROGRESS study, which was an international, prospective, observational registry of ICU patients with severe sepsis. For this st...

La perspective d’une utilisation mieux validée des techniques non invasives d’analyse de l’onde de pouls pourrait offrir de multiples apports en pratique clinique. Dans ce domaine, le monitorage non invasif de la pression artérielle (PA) pourrait permettre un meilleur dépistage des variations tensionnelles rapides dans des situations d’instabilité...

We read with great interest the recent study by Lobo and colleagues stating that fluid restriction during optimization of oxygen delivery (DO2) using dobutamine improves patient outcome after major surgery. Previous studies have shown that haemodynamic optimization using either an individualized goal-directed fluid substitution or inotrope to maxim...

Background: This study aimed to evaluate the implementation of a strategy to prevent postoperative nausea and vomiting (PONV) in patients undergoing general surgery.

Myocardial infarction is rare during pregnancy and is associated with a high maternal and foetal mortality rate. We report the case of a 32-year-old woman at 38 weeks gestation who developed a myocardial infarction with spontaneous coronary dissection treated with coronary angioplasty and who needed an emergency caesarean section. We discuss the an...

Background Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfi rmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after no...

Myocardial infarction is rare during pregnancy and is associated with a high maternal and foetal mortality rate. We report the case of a 32-year-old woman at 38 weeks gestation who developed a myocardial infarction with spontaneous coronary dissection treated with coronary angioplasty and who needed an emergency caesarean section. We discuss the an...

Coagulation disorders in critcally ill patients Coagulation as a whole (comprising both coagulation and fibrinolysis) is a continuously balanced process. This process is an innate immune response limiting both the progression of damage and dissemination of pathogens and allowing both repair and pathogen clearance. Coagulation disorders in criticall...

This study aimed to evaluate the implementation of a strategy to prevent postoperative nausea and vomiting (PONV) in patients undergoing general surgery. Prospective observational study. A first period was observational. During a second period, a strategy to prevent PONV was based on five risk factors (RF) identified after the first phase. From two...

We read with interest the commentary by MacDonald and Pearse [1] stating that only large randomized clinical trials (RCTs) can resolve our uncertainty regarding the value of perioperative hemodynamic therapy. Over the past 20 years, more than 20 small to medium size RCTs and several meta-analyses have shown that perioperative hemodynamic optimizati...

Adequate volume expansion (VE) in patients with evidence of hypoperfusion should be aimed not only at achieving an increase in stroke volume (SV) and cardiac index (CI) but also at improved tissue perfusion and oxygenation. Our aim in this study was to assess the dynamic changes in muscle tissue oxygen saturation (StO₂) during hypovolaemia and in r...

The objective of the present study was to delineate the role of excessive accumulation of mitochondrial nitrogen species contributing to oxidative stress induced by hypoxia/reoxygenation in isolated mitochondria. The present study shows that incubation of isolated rat heart mitochondria under hypoxic, but not anoxic conditions, followed by reoxygen...

Hemodynamic monitoring plays a fundamental role in the management of acutely ill patients. With increased concerns about the use of invasive techniques, notably the pulmonary artery catheter, to measure cardiac output, recent years have seen an influx of new, less-invasive means of measuring hemodynamic variables, leaving the clinician somewhat bew...

IntroductionA questionnaire for self-assessment, the Amsterdam Preoperative Anxiety and Information Scale (APAIS) translated into French has been compared to a background questionnaire to validate their use as screening tool and assessment of anxiety and information needs of patients.

Respiratory arterial pulse pressure variations (PPV) are the best predictors of fluid responsiveness in mechanically ventilated patients during general anesthesia. However, previous studies were performed in a small number of patients and determined a single cutoff point to make clinical discrimination. The authors sought to test the predictive val...

A questionnaire for self-assessment, the Amsterdam Preoperative Anxiety and Information Scale (APAIS) translated into French has been compared to a background questionnaire to validate their use as screening tool and assessment of anxiety and information needs of patients. An epidemiological study was conducted anonymously. Patients completed a que...

Our purpose in conducting this study was to determine whether administration of high-dose tranexamic acid (TA) at the time of diagnosis of postpartum haemorrhage (PPH) could reduce blood loss. This was a randomised, controlled, multicentred, open-label trial. Women with PPH >800 mL following vaginal delivery were randomly assigned to receive TA (lo...

Supported by experimental data, an exciting research topic is the characterization of tissue anaerobic metabolism by the measurement of tissue carbon dioxide (CO2) production. Under conditions of tissue hypoxia a decrease in VO2 is associated with a decrease in aerobic CO2 production, while an anaerobic CO2 production could occur. The rise in parti...

The increase in venous to arterial and tissue to arterial PCO2 differences (Pv-aCO2 and Pt-aCO2) is a constant result found in experimental and clinical studies on circulatory failure. The value of these two gradients depends on the tissue perfusion. In patients with cardiovascular failure, an “anaerobic” CO2 production occurs by buffering H+ ions...

Ischemic postconditioning (IpostC) has been described in both heart and brain. The first aim of this study was to evaluate the effects of IpostC on brain infarct size and neurological function in the middle cerebral artery occlusion (MCAO) model. The second aim was to determine the involvement of the mitochondrial potassium ATP-dependent channel (m...

Adequate tissue perfusion is an essential component of oxygenation in critically ill and high-risk surgical patients. Tissue oxygenation is satisfied when tissue oxygen demand corresponds to oxygen consumption (VO2), which is defined as the product of oxygen delivery (DO2) by the oxygen extraction ratio (O2ER) [1]. Under conditions where DO2 does n...

Hamzaoui and colleagues [1] recently reported the eff ects of early norepinephrine for septic shock with lifethreatening hypotension. Th eir observations fi rst answer ‘yes’ to the question ‘Can norepinephrine alone restore mean arterial pressure (MAP) in septic shock?’ Second, as an answer to ‘How does norepinephrine alone restore MAP?’, they conf...

Central venous oxygen saturation (ScvO2) is a useful therapeutic target in septic shock and high-risk surgery. We tested the hypothesis that central venous-to-arterial carbon dioxide difference (P(cv-a)CO2), a global index of tissue perfusion, could be used as a complementary tool to ScvO2 for goal-directed fluid therapy (GDT) to identify persisten...

The present review of fluid therapy studies using balanced solutions versus isotonic saline fluids (both crystalloids and colloids) aims to address recent controversy in this topic. The change to the acid-base equilibrium based on fluid selection is described. Key terms such as dilutional-hyperchloraemic acidosis (correctly used instead of dilution...

Because tissue hypoxia is a key trigger for organ dysfunction, adequacy of oxygen delivery (DO2) to tissue oxygen metabolic demand is essential during the perioperative period. Optimization of DO2, using either or both fluid loading and inotropic support, to prevent tissue hypoxia in relation to increased oxygen consumption (VO2), could improve out...

To analyze the current knowledge related to xenon anaesthesia. References were obtained from computerized bibliographic research (Medline), recent review articles, the library of the service and personal files. All categories of articles on this topic have been selected. Articles have been analyzed for biophysics, pharmacology, toxicity and environ...

There is substantial evidence to demonstrate the benefits of goal-directed hemodynamic optimization using fluid loading or inotropic support or both to improve outcome during major surgery. However, until now, only limited pathophysiological data have been available to explain this benefit. The maintenance of adequate tissue perfusion and global ox...

Tissue hypoxia is a key trigger for organ dysfunction. The maintenance of adequate tissue oxygenation is therefore of particular importance during major surgery. In this review, we discuss the physiological basis and the rationale underlying the recent concepts of perioperative oxygen therapy. Adequate tissue oxygenation is vital for optimal tissue...

Objective The purpose of this review is to draw up a statement on current knowledge available on the more recent hydroxyethyl starch (HES).

Supplementary tables S1 to S3. A Word file containing further clinical information, and the following tables: Table S1: Organ Dysfunction Definitions; Table S2: Chronic Steroids, High-Dose Corticosteroid and Drotrecogin Alfa (Activated) Patient Hospital Mortality Outcomes for Low-Dose Corticosteroid use (yes/no) and Vasopressor use (yes/no); Table...