Emmanuel Rineau

• MD, PhD
• Lecturer at Centre Hospitalier Universitaire d'Angers

Cardiopulmonary bypass (CPB) during cardiac surgery mechanically circulates and oxygenates the blood, bypassing the heart and lungs. Despite limited evidence, maintaining mechanical ventilation (MV) during CPB is recommended, as ventilator strategies during surgery may reduce the occurrence of postoperative infections. We aimed to determine whether...

Tranexamic acid (TXA) is widely used in various surgical settings to prevent bleeding. Despite extensive evidence supporting its safety and efficacy in many procedures, including hip fracture surgery, it is still largely underused. TXA could be given orally, intravenously or topically pre-, intra- and/or postoperatively. It has been shown to reduce...

Erythropoietin (EPO) is one of the treatments available for managing preoperative anemia and has now been included in several international recommendations on Patient Blood Management, particularly in major orthopedic and cardiac surgeries. Iron deficiency being the leading cause of anemia, iron supplementation is often the first-line treatment pre...

Introduction Iron deficiency, with or without anaemia, is common during the peri‐operative period. It has been hypothesised that pre‐operative iron deficiency is associated with an increased incidence of postoperative infection. We designed the CARIPO prospective observational study to assess the incidence of postoperative infection in patients wit...

OBJECTIVES Antiplatelet therapy increases the risk of bleeding and transfusion in patients undergoing extracorporeal circulation. Reduced goal-directed anticoagulation (RGDA) is a personalized approach to reduce the anticoagulation based on a lower targeted activated clotting time (ACT). We assessed whether RGDA using optimized extracorporeal circu...

Aim To identify and describe microcirculatory dysfunction (MD) in severe COVID-19 cases. Methods This prospective, cohort study evaluated microvascular function in COVID-19 patients with acute respiratory failure not requiring mechanical ventilation and compared it with that of non-COVID-19 intensive care unit (ICU) matched controls. A validation...

Background The COVID-19 pandemic had a global impact on people life, notably because of lockdown periods. This could particularly affected patients suffering from hip fracture, who could have been more isolated during these periods. We aim at evaluating the impact of the COVID-19 period (including lockdown periods) on quality of life (QOL) in older...

Pulmonary embolism is a common complication after intracranial hemorrhage. As thrombolysis is contraindicated in this situation, surgical pulmonary embolectomy may be indicated in case of high-risk pulmonary embolism but requires transient anticoagulation with heparin during cardiopulmonary bypass. We report the case of a patient with a history of...

Background Up to 42% of patients develop acute kidney injury (AKI) after cardiac surgery. The aim of this study was to describe the relationship between preoperative microcirculatory function and postoperative AKI after cardiac surgery using cardiopulmonary bypass (CPB). Methods The prospective observational cohort MONS enrolled 60 patients schedu...

Background Opioid-free anesthesia (OFA) is increasingly being adopted to reduce opioid consumption, but its impact on early postoperative recovery following major surgery has not been evaluated in comparative trials. We hypothesized that an OFA protocol would enhance the early quality of recovery (QoR) for patients undergoing scheduled major surger...

Purpose: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h durat...

Background Pain is frequent after cardiac surgery and source of multiple complications that can impair postoperative recovery. Regional anesthesia seems to be an interesting technique to reduce the pain in this context, but its effectiveness in improving recovery has been poorly studied so far. The objective of this study is to compare the effectiv...

Background: Anaemia and blood transfusion are associated with poor outcomes after hip fracture. We evaluated the efficacy of intravenous iron and tranexamic acid in reducing blood transfusions after hip fracture surgery. Methods: In this double-blind, randomised, 2 × 2 factorial trial, we recruited adults hospitalised for hip fractures in 12 med...

BACKGROUND Major surgery on anemic patients has demonstrated an increased risk of perioperative blood transfusions and postoperative morbidity and mortality. Recent studies have shown that integrating preoperative anemia treatment as a component of Perioperative Blood Management (PBM) may reduce blood product utilization and improve outcomes in bot...

Background Major surgery on patients with anemia has demonstrated an increased risk of perioperative blood transfusions and postoperative morbidity and mortality. Recent studies have shown that integrating preoperative anemia treatment as a component of perioperative blood management may reduce blood product utilization and improve outcomes in both...

Anaemia is common and associated with poor outcomes during and after critical illness. The use of erythropoietin to treat such anaemia is controversial with older studies showing mixed results. In this study, we aimed to evaluate the feasibility of performing a large multicentre randomised controlled trial of erythropoietin in this setting. We rand...

Background Recently, Objective Structured Clinical Examinations (OSCE) became an official evaluation modality for 6-year medical students in France. Before, standard examination modalities were: written progressive clinical cases (PCC), written critical reading of scientific articles (CRA), and internship evaluation (IE). The aim of this study was...

Background Postoperative pain is one of the main factors that delays recovery after prosthetic knee surgery. The use of sufentanil sublingual tablet systems (SSTS) can effectively relieve postoperative pain, but their value in facilitating early mobilization has been little studied so far. Our aim here was to assess whether their use could facilita...

Background: The quality of information during a medical visit, such as a preoperative anesthesia visit, impacts patient's satisfaction. New digital support, including humanoid robots, have been recently proposed to provide medical information to patients. We aimed to assess whether the presence of a PEPPER humanoid robot, programmed to deliver inf...

Objective : Mechanisms and consequences of late-onset hyperlactatemia after cardiac surgery remain unclear. The aim of this study was to identify risk factors and outcomes of late hyperlactatemia, defined as a lactate value ≥3 mmol/L developing in ICU after not being elevated on admission after cardiac surgery with cardiopulmonary bypass. Design :...

Study objective The QoR-15 scale is a validated tool to assess the quality of postoperative recovery (QoR). Our objective was to assess the association between the early QoR-15 values and the occurrence of one-month postoperative complications. Design We used the data from a prospective single-centre cohort study conducted in the Angers University...

Objectives: To compare the neonatal morbidity of caesarean sections (CS) performed after conversion from neuraxial (NA) to general anaesthesia (GA) with CS performed under GA from the outset, and to assess whether the increase in DDI in urgent and extremely urgent cases with conversion from NA to GA increased the risk of neonatal morbidity. Design:...

Various regional anesthesia (RA) techniques were shown to reduce pain after lung surgery, but controversies remain regarding the best technique to use to improve recovery. In this observational prospective study, the aim was to assess the efficacy of an RA strategy depending on the surgical approach. Patients who underwent lung surgery were include...

Background The conversion of neuraxial anesthesia (NA) to general anesthesia (GA) during a cesarean section (CS) may be associated with a higher risk of neonatal morbidity by adding the undesirable effects of both these anesthesia techniques. We aimed to compare the neonatal morbidity of non-elective CS performed after conversion from NA to GA (sec...

Background Pulmonary complications are an important cause of morbidity and mortality after surgery. We evaluated the clinical effectiveness of noninvasive ventilation (NIV) in preventing postoperative acute respiratory failure. Methods This is an open, multicentre randomised trial that included patients at high risk of postoperative pulmonary comp...

Objective Avoiding tracheal intubation by using general anesthesia with spontaneous breathing (GASB) is attractive for upper airway panendoscopy. The aim of this study was to estimate the incidence of adverse events during panendoscopy under GASB and to assess the practices of French anesthesiologists. Study Design Two-phase study: monocentric ret...

Background Cardiac surgery is known to induce acute endothelial dysfunction, which may be central to the pathophysiology of postoperative complications. Preoperative endothelial dysfunction could also be implicated in the pathophysiology of postoperative complications after cardiac surgery. However, the relationship between preoperative endothelial...

Background Since the 2000s, opioid-free anesthesia (OFA) protocols have been spreading worldwide in anesthesia daily practice. These protocols avoid using opioid drugs during anesthesia to prevent short- and long-term opioid side effects while ensuring adequate analgesic control and optimizing postoperative recovery. Proofs of the effect of OFA pro...

When anesthesia checklists and preparations are performed urgently, omissions may occur and be deleterious to the patient. The aim of this study was to evaluate in simulation the interest of a cognitive aid to effectively prepare an anesthetic room for an emergency. In a prospective single-center simulation-based study, 32 anesthesia residents had...

Background Since the 2000s, Opioid Free Anesthesia (OFA) protocols have been spreading worldwide in anesthesia daily practice. These protocols avoid using opioid drugs during anesthesia to prevent short- and long-term opioid side effects while ensuring adequate analgesic control and optimizing postoperative recovery. Proofs of the effect of OFA pro...

Aim: To compare methods of quantifying serum hepcidin (based on MS and ELISA) and their ability to diagnose true iron deficiency anemia in critically ill patients. Materials & methods: Serum hepcidin was measured in 119 critically ill patients included in the HEPCIDANE clinical trial, using either an ultra-sensitive ELISA kit (from DRG) or two diff...

Iron deficiency (ID), with or without anemia, is responsible for physical fatigue. This effect may be linked to an alteration of mitochondrial metabolism. Our aim was to assess the impact of ID on skeletal striated muscle mitochondrial metabolism. Iron-deficient non-anemic mice, obtained using a bloodletting followed by a low-iron diet for three we...

Reintubation after weaning from mechanical ventilation is relatively common and is associated with poor outcomes. Different methods to decrease the reintubation rate post extubation, including noninvasive ventilation, and more recently high-flow oxygen (HFO) therapy, have been proposed. In this study, we aimed to assess the safety of introducing HF...

Introduction Blood transfusion and anaemia are frequent and are associated with poor outcomes in patients with hip fracture (HF). We hypothesised that preoperative intravenous iron and tranexamic acid (TXA) may reduce the transfusion rate in these patients. Methods and analysis The HiFIT study is a multicentre, 2×2 factorial, randomised, double-bl...

Background: The QoR-15 questionnaire is validated to assess the quality of postoperative recovery. There is a need for a French validated version. The objective of this study was to validate a French translation of the QoR-15: the FQoR-15. Methods: We carried out a translation and cultural development of the QoR-15 in the first phase. Adults patie...

Background: Head-to-head comparisons of combinations of more than one non-opioid analgesic (NOA) with morphine alone, for postoperative analgesia, are lacking. The objective of this multicentre, randomised, double-blind controlled trial was to compare the morphine-sparing effects of different combinations of three NOAs—paracetamol (P), nefopam (N),...

Background: Iron deficiency (ID), with or without anemia, is frequent in heart failure patients, and iron supplementation improves patient condition. However, the link between ID (independently of anemia) and cardiac function is poorly understood, but could be explained by an impaired mitochondrial metabolism. Our aim was to explore this hypothesi...

Background: Although continuous renal replacement therapy (CRRT) is common, unplanned interruptions (UI) often limit its usefulness. In many units, nurses are responsible for CRRT management. We hypothesized that a nurse training program based on high-fidelity simulation would reduce the rate of interrupted sessions. Methods: We performed a 2-ph...

Introduction: This work aims to evaluate selection criteria used during the cataract surgery scheduling visit, to choose whether or not there will be an anesthesiologist available during the surgery, depending upon the patient's comorbidities. Materials and methods: Retrospective study performed in 2016 in Angers university medical center. Two g...

Background: Both under-dosage and over-dosage of general anaesthetics can harm frail patients. We hypothesised that computer-assisted anaesthesia using pharmacokinetic/pharmacodynamic models guided by SmartPilot® View (SPV) software could optimise depth of anaesthesia and improve outcomes in patients undergoing hip fracture surgery. Methods: Thi...

Erythropoietin (EPO) is proposed preoperatively to reduce blood transfusion in anemic patients (hemoglobin < 13 g/dL) scheduled for a major orthopedic surgery. New intravenous iron formulations allow infusion of higher doses, increasing EPO response. In that context, we evaluated in a before-after study (n = 62 and 65 patients for each period) a ne...

Introduction: The STOP BANG (SB) questionnaire, a tool originally proposed for identifying patients at risk of Obstructive Sleep Apnoea, may also identify patients at increased risk of perioperative complications (when > 3). Perioperative complications, including respiratory ones, are more frequent in emergency surgery. This study aimed at evaluat...

Background: Patient blood management (PBM) must be promoted in orthopedic surgery and relies on different strategies implemented during the entire perioperative period. Our aim was to assess whether the introduction of a pre-, intra-, and postoperative PBM protocol combining erythropoietin (EPO), ferric carboxymaltose (FCM), and tranexamic acid wa...

Objective: To compare the oxidative stress induced by IV iron infusion in critically ill patients and in healthy volunteers. Design: Multicenter, interventional study. Setting: Two ICUs and one clinical research center. Subjects: Anemic critically ill patients treated with IV iron and healthy volunteers. Interventions: IV infusion of 100 m...

Background: Upon arrival at the emergency department, hip-fracture pain relief is usually carried out via systemic opioids. Continuous nerve blocks are efficient in the postoperative period, but have not been evaluated preoperatively. This study compared the reduction in morphine consumption and related side effects of a continuous femoral block w...

Iron deficiency (ID) is very frequent in cardiac patients and has been associated with altered cardiac function. The correction of ID in patients with heart failure improves clinical symptoms, in patients with or without anemia [1, 2]. Alteration of mitochondrial metabolism due to ID may be responsible for these observations.

Introduction L’érythropoïétine (EPO) réduit la transfusion périopératoire des patients ayant une hémoglobine (Hb) < 13 g/dL en préopératoire de chirurgie orthopédique majeure. L’AMM de l’EPO permet cependant la poursuite des injections tant que l’Hb reste ≤ 15 g/dL. Le but de cette étude est d’évaluer l’intérêt d’un seuil maximal d’Hb de 13 g/dL vs...

Introduction Nous avons souhaité évaluer les pratiques concernant la prise en charge des traumatisés graves au déchocage. L’objectif de cette étude est de mesurer les délais réels de réalisation des différentes procédures à l’accueil des traumatisés sévères et de les comparer aux délais théoriques déclaratifs des réanimateurs du déchocage. Matérie...

Introduction La mortalité individuelle des Traumatisés Graves peut être prédite par le TRISS. Ce score pondéré sur l’âge, le mécanisme du traumatisme, l’ISS et le RTS est la méthode de référence pour l’évaluation de la mortalité des Traumatisés Graves. La performance des équipes, les choix d’organisation ou de traitement peuvent ainsi être évalués...

Introduction L’amélioration du pronostic des TCG repose sur une prise en charge optimale dès le traumatisme. L’intérêt du simulateur HF pour la gestion d’une situation d’urgence complexe et son impact sur la rétention des connaissances a été peu étudié. La simulation HF offre la possibilité d’une évaluation dynamique dans une situation standardisée...

La fréquence de la carence martiale en réanimation est probablement sous-évaluée du fait d’un diagnostic difficile en présence d’inflammation. La découverte de l’hepcidine, principal régulateur du métabolisme du fer, a ouvert des perspectives pour le diagnostic et l’intérêt du traitement martial en réanimation.

Critically ill patients have a high prevalence of anemia. Some of them are already anemic at intensive care unit (ICU) admission, because of surgery, trauma, or their medical history; and around 80 % of them are anemic at ICU discharge. The mechanisms underlying this anemia are multiple and often entangled. Two main mechanisms are involved: inflamm...

Iron is the most prevalent oligo-nutriment and plays a key role in oxygen transport and energy production. Iron deficiency could lead to anemia but also to fatigue or muscular weakness. Iron metabolism is a closed circuit, finely tuned by the peptidic hormone hepcidin to avoid overload as well as deficiency. Inflammation and iron deficiency have op...

Iron as an element is a double-edged sword, essential for living but also potentially toxic through the generation of oxidative stress. The recent study by Chen and colleagues in Critical Care reminds us of this elegantly. In a mouse model of acute lung injury, they showed that silencing hepcidin (the master regulator of iron metabolism) locally in...

Purpose Extent of lung contusion on initial computed tomography (CT) scan predicts the occurrence of acute respiratory distress syndrome (ARDS) in blunt chest trauma patients. We hypothesized that lung ultrasonography (LUS) on admission could also predict subsequent ARDS. Methods Forty-five blunt trauma patients were prospectively studied. Clini...

L’anémie de réanimation est une pathologie fréquente, concernant près de 80 % des patients, et associée à une morbimortalité importante. Sa physiopathologie repose sur un défaut de synthèse et d’effet de l’érythropoïétine et sur des perturbations majeures du métabolisme du fer. Une meilleure connaissance de ce métabolisme et de sa régulation par l’...

Anemia and blood transfusion are risk factors of perioperative morbidity and mortality. There is, consequently, a need for preventive measures. Preventive strategies include preoperative correction of anemia (iron supplementation and erythropoiesis stimulating agent), of preoperative haemorrhage and a decision to provide blood products adapted to e...