Bertrand Guidet

Bertrand Guidet
French Institute of Health and Medical Research U1136 · Medical ICU, Hôpital Saint Antoine, 75012 Paris

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611
Publications
255,327
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17,904
Citations
Citations since 2016
217 Research Items
11064 Citations
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Publications

Publications (611)
Article
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Background Recent multicenter studies identified COVID-19 as a risk factor for invasive pulmonary aspergillosis (IPA). However, no large multicenter study has compared the incidence of IPA between COVID-19 and influenza patients. Objectives To determine the incidence of putative IPA in critically ill SARS-CoV-2 patients, compared with influenza pa...
Article
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Background Vitamin C has potential protective effects through antioxidant and anti-inflammatory properties. However, the effect of vitamin C supplementation on microvascular function and peripheral tissue perfusion in human sepsis remains unknown. We aimed to determine vitamin C effect on microvascular endothelial dysfunction and peripheral tissue...
Article
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Background A dysregulated immune response is emerging as a key feature of critical illness in COVID-19. Neutrophils are key components of early innate immunity that, if not tightly regulated, contribute to uncontrolled systemic inflammation. We sought to decipher the role of neutrophil phenotypes, functions, and homeostasis in COVID-19 disease seve...
Article
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Background Little is known about the impact of hospital trajectory on survival and functional decline of older critically ill patients. We evaluate 6-month outcomes after admission to: intensive care units (ICU), intermediate care units (IMCU) or acute medical wards (AMW). Methods Data from the randomised prospective multicentre clinical trial ICE...
Article
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Background Tracheal intubation and invasive mechanical ventilation initiation is a procedure at high risk for arterial hypotension in intensive care unit. However, little is known about the relationship between pre-existing peripheral microvascular alteration and post-intubation hemodynamic instability (PIHI). Methods Prospective observational mon...
Article
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Background Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV. Methods This i...
Article
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Background COVID-19 remains a complex disease in terms of its trajectory and the diversity of outcomes rendering disease management and clinical resource allocation challenging. Varying symptomatology in older patients as well as limitation of clinical scoring systems have created the need for more objective and consistent methods to aid clinical d...
Article
Résumé Il faut optimiser les différentes étapes de la trajectoire des patients âgés avec une chirurgie à risque. Une approche pluridisciplinaire est nécessaire avec une évaluation préopératoire, une approche « protectrice » au bloc opératoire (protocole d’anesthésie, chirurgie mini-invasive si possible) et parcours postopératoire adapté. Le pronost...
Preprint
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Background: Limitations of life-sustaining therapies (LST) practices are frequent and vary among intensive care units (ICUs). However, scarce data were available during the COVID-19 pandemic when ICUs were under intense pressure. We aimed to investigate the prevalence, timing, modalities, and factors associated with LST decisions in critically-ill...
Article
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During analysis of a prospective multinational observation study of critically ill patients ≥80 years of age, the VIP2 study, we also studied the effects of differences in country consent for study inclusion. This is a post hoc analysis where the ICUs were analyzed according to requirement for study consent. Group A: ICUs in countries with no requi...
Article
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In Europe, tax-based healthcare systems (THS) and social health insurance systems (SHI) coexist. We examined differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in intensive care units in a THS or SHI. Retrospective cohort study. 2406 (THS n = 886; SHI n = 1520) critically ill ≥ 70 years patients in 129 ICUs. Gener...
Article
Background: COVID-19 is associated with cytokine release in critical disease states. Thus, cytokine absorption has been proposed as a therapeutic option. This study investigated the influence of cytokine absorption on mortality in old critical patients with COVID-19 and renal failure admitted to intensive care units (ICU). Methods: This retrospe...
Article
Background Patients suffering from COVID-19 with pre-existing chronic heart failure (CHF) are considered to have a significant risk regarding morbidity and mortality. Similarly, older patients on the intensive care unit (ICU) constitute another vulnerable subgroup. This study investigated the association between pre-existing CHF and clinical practi...
Article
Purpose Prognostication for patients with critical conditions remains challenging, especially for very old individuals. Time-limited trials (TLT) are used to decrease prognostic uncertainty in the individual patient by monitoring the response to treatment over a pre-determined period of time. However, there are substantial difficulties with determi...
Article
Background: Several studies have reported an increased risk of thrombotic events in COVID-19 patients, but the pathophysiology of this procoagulant phenotype remains poorly understood. We hypothesized that corticosteroids may attenuate this procoagulant state through their anti-inflammatory effects. The aim of this study was to evaluate the impact...
Article
PurposeThe biological and functional heterogeneity in very old patients constitutes a major challenge to prognostication and patient management in intensive care units (ICUs). In addition to the characteristics of acute diseases, geriatric conditions such as frailty, multimorbidity, cognitive impairment and functional disabilities were shown to inf...
Article
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Background Ventilator-associated pneumonia (VAP) is common in patients with severe SARS-CoV-2 pneumonia. The aim of this ancillary analysis of the coVAPid multicenter observational retrospective study is to assess the relationship between adjuvant corticosteroid use and the incidence of VAP. Methods Planned ancillary analysis of a multicenter retr...
Article
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Background Capillary refill time (CRT) is a valuable tool for triage and to guide resuscitation. However, little is known about CRT kinetics after fluid infusion. Methods We conducted a prospective observational study in a tertiary teaching hospital. First, we analyzed the intra-observer variability of CRT. Next, we monitored fingertip CRT in seps...
Article
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Purpose: Older critically ill patients with COVID-19 have been the most vulnerable during the ongoing pandemic, with men being more prone to hospitalization and severe disease than women. We aimed to explore sex-specific differences in treatment and outcome after intensive care unit (ICU) admission in this cohort. Methods: We performed a sex-spe...
Chapter
What are the limitations of life-sustaining treatment (LLST)?
Chapter
There is a rapid growing focus on the old and very old ICU patients, and this is reflected in the number of published papers on the subject. Looking at publications listed in PubMed that includes old and intensive care in title or abstract illustrates a very rapid increase from 2010 and onward (Fig. 37.1) demonstrating an exponential increase about...
Book
Full-text available
A comprehensive book with 37 chapters written by authors from all over the world. Usually each chapter is written by a collaboration of an intensivist and a geriatrician. The book is a part of ESICM book series: Lessons from the ICU. The book can be bought as an e-book or in a paper version here: https://link.springer.com/book/10.1007/978-3-030-941...
Article
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Background: Some clinical and histological studies have reported that SARS-CoV-2 infection may damage the endothelium. However, the impact of this virus on endothelial function in vivo remains poorly characterized. In this single-center pilot observational study, we performed iontophoresis of acetylcholine coupled with Laser doppler to investigate...
Article
Background In-hospital cardiac arrest(IHCA) has received little attention compared with out-of-hospital cardiac arrest. Aim To address the paucity of data on IHCA patients, we examined key features, variations in mortality and predictors of death among patients admitted in French intensive care units(ICUs) from 1997 to 2015. Methods Using the dat...
Article
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Background: The COVID-19 pandemic has caused a shortage of intensive care resources. Intensivists' opinion of triage and ventilator allocation during the COVID-19 pandemic is not well described. Methods: This was a survey concerning patient numbers, bed capacity, triage guidelines, and three virtual cases involving ventilator allocations. Physic...
Article
Introduction Prédire le devenir des patients gravement malades hospitalisés en unité de soins intensifs (USI) et atteints de la maladie du coronavirus 19 (COVID-19) est un défi majeur pour éviter les séjours futiles et prolongés en USI. L'objectif de cette recherche était de développer des modèles de prédictifs de la survie à 90 jours applicable à...
Article
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Background In moderate-to-severe COVID-19 pneumonia, dexamethasone (DEX) and tocilizumab (TCZ) reduce the occurrence of death and ventilatory support. We investigated the efficacy and safety of DEX+TCZ in an open randomized clinical trial. Methods From July 24, 2020, through May 18, 2021, patients with moderate-to-severe COVID-19 pneumonia requiri...
Article
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Background: Previous studies reported regional differences in end-of-life care (EoLC) for critically ill patients in Europe. Objectives: The purpose of this post-hoc analysis of the prospective multi-centre COVIP study was to investigate variations in EoLC practices among older patients in intensive care units during the coronavirus disease 2019...
Article
Background Limited evidence suggests variation in mortality of older critically ill adults across Europe. We aimed to investigate regional differences in mortality among very old ICU patients. Methods Multilevel analysis of two international prospective cohort studies. We included patients ≥80 yr old from 322 ICUs located in 16 European countries....
Article
Purpose: This study aimed to investigate the association between the use of early echocardiography performed by the treating physician certified in critical care ultrasound and mortality in ICU patients. Materials and methods: FROG-ICU was a multi-center cohort designed to investigate the outcome of critically ill patients. Of the 1359 patients...
Article
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Aims: Chronic heart failure (CHF) is a major risk factor for mortality in coronavirus disease 2019 (COVID-19). This prospective international multicentre study investigates the role of pre-existing CHF on clinical outcomes of critically ill old (≥70 years) intensive care patients with COVID-19. Methods and results: Patients with pre-existing CHF...
Article
Background The first COVID-19 wave started in February 2020 in France. The influx of patients requiring emergency care and high-level technicity led healthcare professionals to fear saturation of available care. In that context, the multidisciplinary Ethics- Support Cell (EST) was created to help medical teams consider the decisions that could pote...
Article
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Purpose: Critically ill old intensive care unit (ICU) patients suffering from Sars-CoV-2 disease (COVID-19) are at increased risk for adverse outcomes. This post hoc analysis investigates the association of the Activities of Daily Living (ADL) with the outcome in this vulnerable patient group. Methods: The COVIP study is a prospective internatio...
Article
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Purpose: The number of patients ≥ 80 years admitted into critical care is increasing. Coronavirus disease 2019 (COVID-19) added another challenge for clinical decisions for both admission and limitation of life-sustaining treatments (LLST). We aimed to compare the characteristics and mortality of very old critically ill patients with or without CO...
Article
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Purpose: Acute mesenteric ischemia (AMI) is a rare, but life-threatening condition occurring among critically ill patients. Several factors have been associated with AMI, but the causal link is debated, most studies being retrospective. Among these factors, enteral nutrition (EN) could be associated with AMI, in particular among patients with shoc...
Article
Importance: Persistent physical and mental disorders are frequent in survivors of COVID-19-related acute respiratory distress syndrome (ARDS). However, data on these disorders among family members are scarce. Objective: To determine the association between patient hospitalization for COVID-19 ARDS vs ARDS from other causes and the risk of posttr...
Article
Introduction The age of patients admitted into critical care in the UK is increasing. Clinical decisions for very-old patients, usually defined as over 80, can be challenging. Clinicians are frequently asked to predict outcomes as part of discussions around the pros and cons of an intensive care unit (ICU) admission. Measures of overall health in o...
Article
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Background: health-related quality of life (HRQoL) is an important patient-centred outcome in patients surviving ICU admission for COVID-19. It is currently not clear which domains of the HRQoL are most affected. Objective: to quantify HRQoL in order to identify areas of interventions. Design: prospective observation study. Setting: admissio...
Article
Purpose: Whether epinephrine or norepinephrine is preferable as the continuous intravenous vasopressor used to treat post-resuscitation shock is unclear. We assessed outcomes of patients with post-resuscitation shock after out-of-hospital cardiac arrest according to whether the continuous intravenous vasopressor used was epinephrine or norepinephr...
Article
Background: SARS-CoV-2 pneumonia is responsible for unprecedented numbers of acute respiratory failure requiring invasive mechanical ventilation (IMV). This work aimed to assess whether adding face-mask noninvasive ventilation (NIV) to high-flow nasal oxygen (HFNO) was associated with a reduced need for endotracheal intubation. Methods: This ret...
Article
PRIORISATION OF OLD CRITICALLY-ILL PATIENTS FOR AN ICU ADMISSION There are currently no national or international recommendations for admission decisions to an intensive care unit (icu) for patients over 80 years of age. The decision, whether, or not to admit an elderly patient to intensive care is probably one of the most difficult decisions for a...
Article
Full-text available
Little is known about the immuno-inflammatory response to Tocilizumab and its association with outcome in critically-ill SARS-CoV2 pneumonia. In this multicenter retrospective cohort of SARS-CoV-2 patients admitted to three intensive care units between March and April 2020, we matched on gender and SAPS II 21 Tocilizumab-treated patients to 42 non-...
Article
Full-text available
Background: health-related quality of life (HRQoL) is an important patient-centred outcome in patients surviving ICU admission for COVID-19. It is currently not clear which domains of the HRQoL are most affected. Objective: to quantify HRQoL in order to identify areas of interventions. Design: prospective observation study. Setting: admissions to E...
Chapter
This introduction gives an overview of the demography of ageing in particular in a short (20–30-year) perspective. For this time period we already know a lot how the future populations will be composed, and the number of old and very old will increase considerably in most countries. In the developed countries this is accompanied by a decrease in th...
Preprint
Full-text available
Background Emerging data based on analyses of peripheral and pulmonary immune responses to SARS-CoV-2 increasingly suggest that a dysregulated immune response underpins the development of severe disease in COVID-19 patients. Neutrophils are key components of early innate immunity that, if not tightly regulated, contribute to uncontrolled systemic i...
Article
Background: The SARS-CoV-2 coronavirus disease (COVID-19) pandemic is challenging health care systems globally. The disease disproportionately affects the elderly population, both in terms of disease severity and mortality risk. Objective: This study aimed to evaluate machine-learning based prognostication models for critically ill elderly COVID...
Article
Full-text available
Background SARS coronavirus 2 (SARS-CoV-2) is responsible for high morbidity and mortality worldwide, mostly due to the exacerbated inflammatory response observed in critically ill patients. However, little is known about the kinetics of the systemic immune response and its association with survival in SARS-CoV-2+ patients admitted in ICU. We aimed...
Article
Full-text available
Purpose Frailty is a valuable predictor for outcome in elderly ICU patients, and has been suggested to be used in various decision-making processes prior to and during an ICU admission. There are many instruments developed to assess frailty, but few of them can be used in emergency situations. In this setting the clinical frailty scale (CFS) is fre...
Article
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Background: Little is known on the outcome and risk factors for mortality of patients admitted in Intensive Care units (ICUs) for Acute cholangitis (AC). Methods: Retrospective multicenter study included adults admitted in eleven intensive care units for a proven AC from 2005 to 2018. Risk factors for in-hospital mortality were identified using...
Article
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Background The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions re...
Article
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Background The COVID-19 pandemic is a heavy burden in terms of health care resources. Future decision-making policies require consistent data on the management and prognosis of the older patients (> 70 years old) with COVID-19 admitted in the intensive care unit (ICU). Methods Characteristics, management, and prognosis of critically ill old patien...
Article
Full-text available
Following publication of the original article [1], the authors identified an error in the Abstract and Results section. The correct numbers and text are given hereafter. Abstract VAP was associated with significantly higher risk for 28-day mortality in SARS-CoV-2 group (adjusted HR 1.65 (95% CI 1.11–2.46), p = 0.013), but not in influenza (1.74 (0....
Article
Full-text available
There is ongoing demographic ageing and increasing longevity of the population, with previously devastating and often-fatal diseases now transformed into chronic conditions. This is turning multi-morbidity into a major challenge in the world of critical care. After many years of research and innovation, mainly in geriatric care, the concept of mult...
Article
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Background Echocardiographic parameters have been poorly investigated for estimating cardiovascular risk in patients with sepsis and new-onset atrial fibrillation. We aim to assess the prevalence of transesophageal echocardiographic abnormalities and their relationship with cardiovascular events in mechanically ventilated patients with sepsis and n...