Francois Philippart

Hôpital Paris Saint Joseph · Intensive care medicine

Background: COVID-19-related acute respiratory distress syndrome (CARDS) is a severe evolution of the Sars-Cov-2 infection and necessitates intensive care. COVID-19 may subsequently be associated with long COVID, whose symptoms can include persistent respiratory symptoms up to 1 year later. Rehabilitation is currently recommended by most guideline...

Background: Fasting is frequently imposed before extubation in patients in intensive care units, with the aim to reduce risk of aspiration. This unevaluated practice might delay extubation, increase workload, and reduce caloric intake. We aimed to compare continued enteral nutrition until extubation with fasting before extubation in patients in th...

Background The ageing of the population and the increased number of chronic diseases are associated with an increased frequency of end of life care in hospital settings. Residents rotating in hospital wards play a major part in their care, regardless of their specialty. General practitioner (GP) residents are confronted to such activities in hospit...

Background: Although sepsis is a life-threatening condition, its heterogeneous presentation likely explains the negative results of most trials on adjunctive therapy. This study in patients with sepsis aimed to identify subgroups with similar immune profiles and their clinical and outcome correlates. Methods: A secondary analysis used data of a...

Background COVID-19-related Acute Respiratory Distress Syndrome (CARDS) is the severe evolution of the Sars-Cov-2 infection leading to an intensive care unit (ICU) stay. Its onset is associated with “long-covid” including persisting respiratory disorders up to one year. Rehabilitation is suggested by most guidelines in the treatment of “long-covid”...

Background Although sepsis is a life-threatening condition, its heterogeneous presentation likely explains the negative results of most trials on adjunctive therapy. This study in patients with sepsis aimed to identify subgroups with similar immune profiles and their clinical and outcome correlates. Methods A secondary analysis used data of a pros...

Background: The potential influence of thoracic ultrasound on clinical decision-making by physiotherapists has never been studied. The aim of this study was to assess the impact of thoracic ultrasound on clinical decision-making by physiotherapists for critical care patients. Methods: This prospective, observational multicentre study was conduct...

Background Previous literature on the determinants of diaphragm dysfunction in septic patients is limited. The goal of this study is to assess diaphragm dysfunction in terms of its prevalence and its potential associated factors in septic intensive care unit (ICU) patients. Methods This prospective and observational study was conducted between Jun...

A 61-year-old black male from Benin with a history of type 2 diabetes mellitus was hospitalized in Cotonou, Benin for asthenia. Five days later, he presented an acute respiratory failure leading to its transfer in an intensive care unit. He required mechanical ventilation and received an empirical antibiotic therapy with piperacillin/tazobactam and...

Patients living with cancer often experience serious adverse events due to their condition or its treatments. Those events may lead to a critical care unit admission or even result in death. One of the most important but challenging part of care is to build a caring plan according to the patient’s wishes, meeting his goals and values. Advance direc...

Background The death rate in intensive care units (ICUs) can reach 20%. More than half occurs after a decision of care withholding/withdrawal. We aimed at describing and evaluating the experience of ICU physicians and nurses involved in the end-of-life (EOL) procedure. Primary objective was the evaluation of the experience of EOL assessed by the CA...

In the original publication of the article [1], one of the author’s name was published incorrectly as Michael Piagnarelli instead of Michael Piagnerelli. The original article has been corrected.

Riassunto Nell’attuale contesto di aumento della prevalenza dei batteri multiresistenti (BMR) e altamente resistenti (BHRe), la gestione delle epidemie e della trasmissione di questi germi in terapia intensiva sembra essere un problema importante. La diffusione di questi germi nelle unità di terapia intensiva è principalmente mediata, da un lato, d...

Resumen En el actual contexto de aumento de la prevalencia de bacterias multirresistentes (BMR) y altamente resistentes (BARe), el manejo de las epidemias y de la transmisión de estos gérmenes en cuidados intensivos se muestra como un desafío de primer orden. La propagación de estos gérmenes en las unidades de cuidados intensivos está mediada princ...

Riassunto Le principali infezioni nosocomiali (IN) rappresentano un pericolo particolarmente significativo in terapia intensiva, dove i pazienti sono fragili ed esposti a molti dispositivi invasivi. I principali siti esposti al rischio di infezione sono il polmone, in particolare nelle polmoniti acquisite sotto ventilazione meccanica, le infezioni...

Resumen Las principales infecciones nosocomiales (IN) representan un peligro especialmente importante en reanimación, donde los pacientes son frágiles y están expuestos a numerosos dispositivos invasivos. Las principales localizaciones expuestas al riesgo infeccioso son el pulmón, en particular en el marco de las neumonías adquiridas bajo ventilaci...

We assessed in a pilot prospective study, the relationship between the faecal relative abundance of ESBL-PE and the occurrence of ESBL-PE related infections. Twenty-four patients were included. The median ESBL-relative abundance was 32.4%. The mean ESBL-PE-relative abundance (ESBL-PE-RA) was more than 5-fold higher in patient exposed during the las...

Background: Patients admitted in intensive care units often receive mechanical ventilation. Prior to extubation, the weaning process could be a major cause of dyspnea and anxiety in awake intubated patients. Hypnotherapy is nowadays commonly used to manage anxiety and pain. Our hypothesis is that hypnosis would decrease stress during the weaning an...

Background: Patients admitted in intensive care units often receive mechanical ventilation. Prior to extubation, weaning process could be a major cause of dyspnea and anxiety in awake intubated patients. Hypnosis is commonly used to manage anxiety and pain. Our hypothesis is that hypnosis would decrease stress during the weaning and extubation proc...

Background : Patients admitted in intensive care units often receive mechanical ventilation. Prior to extubation, weaning process could be a major cause of dyspnea and anxiety in awake intubated patients. Hypnosis is commonly used to manage anxiety and pain. Our hypothesis is that hypnosis would decrease stress during the weaning and extubation pro...

Background The accuracy of diaphragm ultrasound for predicting weaning outcome is still debated, despite the publication of numerous studies evaluating this issue. Objective The aim of this systematic review and meta-analysis was to assess the diagnostic accuracy of diaphragm ultrasound for predicting weaning failure in critically ill patients. D...

The pandemic of coronavirus disease 2019 (Covid-19) caused a large number of non-ventilated hypoxemic patients to require the use of prone position. The aim of this study is to measure the efficiency and tolerance of prone positioning in ward hypoxemic patients treated for Covid-19. This retrospective study included confirmed Covid-19 hypoxemic pat...

The pandemic of coronavirus disease 2019 (Covid-19) caused a large number of non-ventilated hypoxemic patients to require the use of prone position. The aim of this study is to measure the efficiency and tolerance of prone positioning in ward hypoxemic patients treated for Covid-19. This retrospective study included confirmed Covid-19 hypoxemic pat...

The ageing of the population and the increased number of chronicle diseases are associated with an increased frequency of end of life care in hospital settings. Residents rotating in hospital wards play a major part in their care, regardless of their specialty. General practitioner (GP) residents are confronted to such activities in hospital settin...

Les résultats de cette deuxième enquête menée sous l'égide du CNSPFV pour approcher la réalité de la SPCJD sur le terrain, trois ans après l'adoption de la loi de 2016, montre que les SPCJD mises en oeuvre au cours de la semaine investiguée, dans les quelques hôpitaux investigués, l'ont été très majoritairement sur proposition médicale en soutien d...

Objectives: To describe the epidemiology and prognostic impact of pneumonia in acute ischemic stroke patients requiring invasive mechanical ventilation. Methods: Retrospective analysis from a prospective multicenter cohort study of critically ill patients with acute ischemic stroke requiring invasive mechanical ventilation at admission. Impact o...

Background The doctor-patient relationship has evolved to respect “the autonomy and patients’ rights”. One of the cornerstones in such autonomy is the opportunity for patients to draw living wills, also known as advance directives (AD). However, information about AD available to patients remains scarce largely due to the lack of involvement of Gene...

La cholécystite aiguë de réanimation (0,2 à 1 % des patients) est liée à des facteurs de risque spécifiques (jeûne, nutrition parentérale, ventilation mécanique) et systémiques (instabilité, brûlures graves, catécholamines) conduisant à des phénomènes d’ischémie-reperfusion de la paroi vésiculaire, à l’origine d’une cholécystite classiquement alith...

Ventilator-associated pneumonia remain frequent and serious diseases since they are associated with considerable crude mortality. Pathophysiology is centered on modifications of regional bacterial flora, especially tracheobronchial tree and oropharyngeal sphere. Bacterial migration from an anatomical area to another seems to be the main explanation...

Background The use of diagnostic ultrasound by physiotherapists is not a new concept; it is frequently performed in musculoskeletal physiotherapy. Physiotherapists currently lack accurate, reliable, sensitive and valid measurements for the assessment of the indications and effectiveness of chest physiotherapy. Thoracic ultrasound may be a promising...

PurposeSepsis and non-septic systemic inflammatory response syndrome (SIRS) are the same syndromes, differing by their cause, sepsis being secondary to microbial infection. Microbiological tests are not enough to detect infection early. While more than 50 biomarkers have been proposed to detect infection, none have been repeatedly validated. AimTo...

Table S1. The Variables Entered in the Analysis Table S2. Baseline Characteristics of Patients (n=361)* Table S3. Surgical Features (n=361)* Table S4. Endocarditis‐Related Features (n=361)*

Tuberculosis is one of the main etiologies to evoke in the context of lymphocyte pleurisy. However, diagnosis is difficult and is based on mycobacteriology that is not enough sensitive and time-consuming, or on histology that requires invasive biopsy gesture. This literature review, carried out from Medline, summarizes the main meta-analyzes, revie...

Introduction Le sepsis peut se définir comme une réponse inflammatoire systémique à une infection. Le choc septique en est la forme la plus grave et associe des défaillances viscérales. Il nécessite une hospitalisation en réanimation, où il est fréquemment rencontré. Parmi les différents organes affectés lors du choc septique, on retrouve le muscle...

Objectives: To investigate family perceptions of having a nurse participating in family conferences and to assess the psychologic well being of the same families after ICU discharge. Design: Mixed-method design with a qualitative study embedded in a single-center randomized study. Setting: Twelve-bed medical-surgical ICU in a 460-bed tertiary hospi...

Table of contents: PHYSICIANS ABSTRACTSO1 Impact of tracheal cuff shape on microaspiration of gastric contents in intubated critically ill patients: a multicenter randomized controlled study (BEST CUFF)Emmanuelle Jaillette, Christophe Girault, Guillaume Brunin, Farid Zerimech, Arnaud Chiche, Céline Broucqsault-Dedrie, Cyril Fayolle, Franck Minacor...

The use of diagnostic ultrasound by physiotherapists is not a new concept; it is frequently performed in musculoskeletal physiotherapy. Physiotherapists currently lack accurate, reliable, sensitive, and valid measurements for the assessment of the indications and effectiveness of chest physiotherapy. Thoracic ultrasound may be a promising tool for...

Body temperature elevation in critically ill patients is a frequent phenomenon that is typically the result of the systemic inflammatory response syndrome. In nearly one half of the cases, this is the result of an infectious process that often mandates an operative intervention and/or immediate antibiotic therapy. Other less common etiologies such...

Objectives: To investigate family perceptions of having a nurse participating in family conferences and to assess the psychologic well being of the same families after ICU discharge. Design: Mixed-method design with a qualitative study embedded in a single-center randomized study. Setting: Twelve-bed medical-surgical ICU in a 460-bed tertiary...

Rationale: Experimental studies suggest that intra-abdominal infection (IAI) induces biological alterations that may affect the risk of lung infection. Objectives: To investigate the potential effect of IAI at ICU admission on the subsequent occurrence of ventilator-associated pneumonia (VAP). Methods: We used data entered into the French pros...

Le polmoniti acute comunitarie (PAC) sono delle patologie infettive respiratorie frequenti e potenzialmente gravi, allo stesso tempo a causa della virulenza dell’agente patogeno responsabile e della fragilita del terreno del paziente. La valutazione della gravita della lesione deve essere sistematica, per permettere l’orientamento e la gestione piu...

Las neumonías agudas comunitarias (NAC) son patologías infecciosas respiratorias frecuentes y potencialmente graves, no sólo por la virulencia del agente patógeno responsable, sino también por la fragilidad del paciente. La gravedad de la lesión debe evaluarse de forma sistemática para orientar e instaurar el tratamiento más apropiado. Las escalas...

Emerging resistance to antibiotics shows no signs of decline. At the same time, few new antibacterials are being discovered. There is a worldwide recognition regarding the danger of this situation. The urgency of the situation and the conviction that practices should change led the Société de Réanimation de Langue Française (SRLF) and the Société F...

To report an unusual case of suicide attempt secondary complicated of pulmonary and systemic embolisms. A 49-year-old-woman, with a factor V Leiden mutation and a notion of chronic depression, admitted to our intensive care unit for a suicide attempt by ingestion ofmepronizine and lormetazepam. We report the rare evolution of this patient with a pe...

Rationale: The occurrence of ventilator-associated pneumonia (VAP) is linked to the aspiration of contaminated pharyngeal secretions around the endotracheal tube. Tubes with cuffs made of polyurethane rather than polyvinyl chloride or with a conical rather than a cylindrical shape increase tracheal sealing. Objectives: To test whether using poly...

Purpose Keeping an ICU patient diary has been reported to benefit the patient's recovery. Here, we investigated the families' experience with reading and writing in patient ICU diaries kept by both the family and the staff. Methods We conducted a qualitative study involving 32 semi-structured in-depth interviews of relatives of 26 patients (34% of...

Introduction La survenue de pneumonies acquises sous ventilation mecanique (PAVM) est liee en grande partie a la colonisation bacterienne de l’oro-pharynx des patients et a la mauvaise etancheite du ballonnet de la sonde d’intubation. Des essais preliminaires suggerent que le materiau en polyurethane (plutot qu’en PVC) et la forme conique (plutot q...

Apoptosis is the most common pathway of neutrophil death under both physiological and inflammatory conditions. In this study, we describe an apoptotic pathway in human neutrophils that is triggered via the surface molecule CD24. In normal neutrophils, CD24 ligation induces death through depolarization of the mitochondrial membrane in a manner depen...

Contact isolation of infected or colonised hospitalised patients is instrumental to interrupting multidrug-resistant organism (MDRO) cross-transmission. Many studies suggest an increased rate of adverse events associated with isolation. We aimed to compare isolated to non-isolated patients in intensive care units (ICUs) for the occurrence of advers...

In the context of worldwide increasing antimicrobial resistance, good antimicrobial prescribing in more needed than ever; unfortunately, information available to clinicians often are insufficient to rely on. Biomarkers might provide help for decision-making and improve antibiotic management. The purpose of this expert panel review was to examine cu...

List of biomarkers tested in the field of infectious diseases.

Biomarker-guided initiation of antibiotic therapy has been studied in four conditions: acute pancreatitis, lower respiratory tract infection (LRTI), meningitis, and sepsis in the ICU. In pancreatitis with suspected infected necrosis, initiating antibiotics best relies on fine-needle aspiration and demonstration of infected material. We suggest that...

Purpose: To assess physician decisions about ICU admission for life-sustaining treatments (LSTs). Methods: Observational simulation study of physician decisions for patients aged ≥80 years. Each patient was allocated at random to four physicians who made decisions based on actual bed availability and existence of an additional bed before and aft...

Purpose: To assess preferences among individuals aged ≥80 years for a future hypothetical critical illness requiring life-sustaining treatments. Methods: Observational cohort study of consecutive community-dwelling elderly individuals previously hospitalised in medical or surgical wards and of volunteers residing in nursing homes or assisted-liv...

Despite many therapeutic interventions, ventilator-acquired pneumonias (VAP) are frequent in the ICU and are associated with major morbidity and mortality. Sepsis causes a time-dependent modification of the inflammatory response. This reprogramming could promote the occurrence of a secondary infection and worsen the prognosis. In animals, peritonit...

Los servicios de reanimación deben organizar de forma minuciosa la prevención de infecciones en sus enfermos, ya que éstos suelen estar inmunodeprimidos, están sometidos a múltiples procedimientos invasivos realizados por un personal sanitario variado, a menudo en situaciones de urgencia y a cualquier hora del día o de la noche. Las principales inf...

I servizi di rianimazione devono organizzare la prevenzione delle infezioni nei loro pazienti in modo minuzioso, in quanto i pazienti sono spesso immunodepressi e subiscono gesti invasivi molteplici, realizzati da personale differente, spesso in situazioni di urgenza e a qualsiasi ora del giorno o della notte. Le principali infezioni che bisogna te...

Introduction Studies have reported associations between diaries kept for intensive care unit (ICU) patients and long-term quality-of-life and psychological outcomes in patients and their relatives. Little was known about perceptions of healthcare workers reading and writing in the diaries. We investigated healthcare worker perceptions the better to...