Pierre Kalfon

Pierre Kalfon
C.H. de Chartres · Réanimation

MD, PhD, MBA

About

103
Publications
21,708
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3,295
Citations
Additional affiliations
October 1996 - December 2002
Deaconess Hospital Group Croix Saint - Simon
Position
  • Head of Department

Publications

Publications (103)
Article
Full-text available
Background Severe hypoxemia in patients with COVID-19 pneumonia might result from hypoxic pulmonary vasoconstriction, contributing to ventilation/perfusion (V/Q) mismatch. Because almitrine improves V/Q, it might reduce the risk for mechanical ventilation (MV) in such patients. Our primary objective was to determine the effect of almitrine on the n...
Article
Purpose: Compared to long duration of antibiotic therapy, a short duration has a comparable clinical efficacy for ventilator-associated pneumonia (VAP), with the exception of documented VAP of non-fermenting Gram-negative bacilli (NF-GNB), including Pseudomonas aeruginosa (PA). We aimed to assess the non-inferiority of a short duration of antibiot...
Article
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Introduction: Prognosis of patients with COVID-19 depends on the severity of the pulmonary affection. The most severe cases may progress to acute respiratory distress syndrome (ARDS), which is associated with a risk of long-term repercussions on respiratory function and neuromuscular outcomes. The functional repercussions of severe forms of COVID-...
Preprint
UNSTRUCTURED Introduction: Critically ill patients are at risk to develop a Post-Intensive Care Syndrome (PICS), which is characterized by physical, psychological and cognitive impairments and dramatically impacts the quality of life. No intervention has been shown to improve the quality of life (QoL). Because of the interdependency of its domains,...
Article
Full-text available
Background: Critically ill patients are at risk of developing a postintensive care syndrome (PICS), which is characterized by physical, psychological, and cognitive impairments and which dramatically impacts the patient's quality of life (QoL). No intervention has been shown to improve QoL. We hypothesized that a medical, psychological, and social...
Article
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Background: Studies describing the clinical features and short-term prognosis of patients admitted to the intensive care unit (ICU) for menstrual toxic shock syndrome (m-TSS) are lacking. Methods: This was a multicenter retrospective cohort study of patients with a clinical diagnosis of m-TSS admitted between January 1, 2005 and December 31, 2020...
Article
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Objectives To assess the incidence of sink contamination by multidrug-resistant (MDR) Pseudomonas aeruginosa and Enterobacteriaceae, risk factors for sink contamination and splashing, and their association with clinical infections in the intensive care setting. Methods A prospective French multicenter study (1 January-30 May 2020) including in eac...
Article
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Background The short-term and long-term consequences of the most frequent painful procedures performed in the ICU are unclear. This study aimed to identify the risk factors associated with pain-related discomfort perceived by critically ill patients during the whole ICU stay as self-reported by patients at the end of their ICU stay. Methods The st...
Article
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Background: Whereas 5415 Intensive Care Unit (ICU) beds were initially available, 7148 COVID-19 patients were hospitalised in the ICU at the peak of the outbreak. The present study reports how the French Health Care system created temporary ICU beds to avoid being overwhelmed. Methods: All French ICUs were contacted for answering a questionnaire...
Preprint
Full-text available
Background: The short-term and long-term consequences of the most frequent painful procedures performed in the ICU are unclear. This study aimed to identify the risk factors associated with pain-related discomfort perceived by critically ill patients during the whole ICU stay as self-reported by patients at the end of their ICU stay. Methods: The s...
Preprint
Full-text available
Background: The short-term and long-term consequences of the most frequent painful procedures performed in the ICU are unclear. This study aimed to identify the risk factors associated with pain-related discomfort perceived by critically ill patients during the whole ICU stay as self-reported by patients at the end of their ICU stay. Methods: The s...
Preprint
Full-text available
Background: The short-term and long-term consequences of the most frequent painful procedures performed in the ICU are unclear. This study aimed to identify the risk factors associated with pain-related discomfort perceived by critically ill patients during the whole ICU stay as self-reported by patients at the end of their ICU stay. Methods: The s...
Article
Full-text available
Methods to control the blood glucose (BG) levels of patients in intensive care units (ICU) improve the outcomes. The development of continuous BG levels monitoring devices has also permitted to optimize these processes. Recently it was shown that a complexity loss of the BG signal is linked to poor clinical outcomes. Thus, it becomes essential to d...
Article
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Background and aims We reported the validation of the 18-item version of the ‘Inconforts des Patients de REAnimation (IPREA)’ questionnaire that includes 2 new items exploring feeling depressed and shortness of breath during an intensive care unit (ICU) stay. Methods The validation process was integrated in a multicenter, cluster-randomized, contr...
Article
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Purpose Reducing discomfort in the intensive care unit (ICU) should have a positive effect on long-term outcomes. This study assessed whether a tailored multicomponent program for discomfort reduction was effective in reducing post-traumatic stress disorder (PTSD) symptoms at 1 year in general ICU survivors. Methods This study is a prospective obs...
Article
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There is considerable physiological and clinical evidence of harm and increased risk of death associated with dysglycemia in critical care. However, glycemic control (GC) currently leads to increased hypoglycemia, independently associated with a greater risk of death. Indeed, recent evidence suggests GC is difficult to safely and effectively achiev...
Article
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Résumé Une patiente primipare de 27 ans a accouché à 35 semaines d’aménorrhée. Le post-partum a été marqué par une hémorragie de la délivrance (HD) et une défaillance multiviscérale, ayant nécessité en plus de l’expansion volémique et des transfusions de produits sanguins labiles, des vasopresseurs à fortes doses, la ventilation mécanique invasive...
Article
Background: The efficacy of venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome (ARDS) remains controversial. Methods: In an international clinical trial, we randomly assigned patients with very severe ARDS, as indicated by one of three criteria - a ratio of partial pressure of arteri...
Article
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Glucose management in intensive care unit (ICU) patients has been a matter of debate for almost two decades. Compared to intermittent monitoring systems, continuous glucose monitoring (CGM) can offer benefit in the prevention of severe hyperglycemia and hypoglycemia by enabling insulin infusions to be adjusted more rapidly and potentially more accu...
Article
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Purpose: Critically ill patients are exposed to stressful conditions and experience several discomforts. The primary objective was to assess whether a tailored multicomponent program is effective for reducing self-perceived discomfort. Methods: In a cluster-randomized two-arm parallel trial, 34 French adult intensive care units (ICUs) without pl...
Article
Background: Whether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than with early first-line parenteral nutrition. Methods: In this randomised, controlled, multicentre, open-label, parallel-group study (NUT...
Article
Background: Different modes of death are described in selected populations, but few data report the characteristics of death in a general intensive care unit population. This study analyzed the causes and characteristics of death of critically ill patients and compared anticipated death patients to unexpected death counterparts. Methods: An obse...
Article
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Background: Ventilator-associated pneumonia (VAP) accounts for 25% of infections in intensive care units. Compared to a long duration (LD) of antibiotic therapy, a short duration (SD) has a comparable clinical efficacy with less antibiotic use and less multidrug-resistant (MDR) pathogen emergence, with the exception of documented VAP of non-fermen...
Article
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Une patiente primipare de 16 ans a accouché à 41 semaines d’aménorrhée. Le post-partum a été marqué par une atonie utérine suivie d’une hémorragie de la délivrance compliquée d’une coagulation intravasculaire disséminée et d’un HELLP syndrome, sans instabilité hémodynamique. Les mesures thérapeutiques mises en place comprenaient des produits sangui...
Article
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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...
Article
In the present era of near-continuous glucose monitoring (CGM) and automated therapeutic closed-loop systems, measures of accuracy and of quality of glucose control need to be standardized for licensing authorities and to enable comparisons across studies and devices. Adequately powered, good quality, randomized, controlled studies are needed to as...
Article
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It is now well documented that critically ill patients are exposed to stressful conditions and experience discomforts from multiple sources. Improved identification of the discomforts of patients in intensive care units (ICUs) may have implications for managing their care, including consideration of ethical issues, and may assist clinicians in choo...
Article
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Background: Three anatomical sites are commonly used to insert central venous catheters, but insertion at each site has the potential for major complications. Methods: In this multicenter trial, we randomly assigned nontunneled central venous catheterization in patients in the adult intensive care unit (ICU) to the subclavian, jugular, or femora...
Article
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Using a randomized controlled trial comparing tight glucose control with a computerized decision-support systems and conventional protocols (post hoc analysis), we tested the hypothesis that hypoglycemia is associated with a poor outcome, even when controlling for initial severity. We looked for moderate (2.2-3.3 mmol/l) and severe (<2.2 mmol/l) hy...
Article
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IntroductionHyperglycemia is a marker of poor prognosis in severe brain injuries. There is currently little data regarding the effects of intensive insulin therapy (IIT) on neurological recovery.MethodsA sub-group analysis of the randomized-controlled CGAO-REA study (NCT01002482) in surgical intensive care units (ICU) of two university hospitals. P...
Article
Introduction Les objectifs du controle glycemique en reanimation se sont complexifies depuis la premiere etude de Louvain [1] mettant en evidence une reduction de mortalite associee au seul respect d’une cible glycemique stricte (4,4–6,1 mmol/L). Au-dela de la controverse concernant la cible glycemique qui s’en est suivie, hypoglycemie et variabil...
Article
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Stress-induced hyperglycemia is common in critically ill patients due to insulin resistance and increased hepatic output of glucose. The relationship between stress hyperglycemia and poor outcome for patients hospitalized in the intensive care unit (ICU) was already established when Van den Berghe et al demonstrated that tight glucose control (TGC)...
Article
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The blood glucose target range and optimal method to reach this range remain a matter of debate in the intensive care unit (ICU). A computer decision support system (CDSS) might improve the outcome of ICU patients through facilitation of a tighter blood glucose control. We conducted a multi-center randomized trial in 34 French ICU. Adult patients e...
Article
Catheter-associated infections are common, costly, and potentially lethal. The impact of catheter insertion site on infection risk remains controversial. We aimed to establish whether nontunneled central venous catheters inserted in the subclavian vein are associated with lower risk of catheter-associated infection compared to femoral or internal j...
Article
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While minimizing glycemic variability (GV) during glucose control in critical care patients could become a new therapeutic goal, it is important to have a reliable assessment of GV. The aim of the study is to compare a real continuous glucose monitoring (CGM) system in comparison with a semi-continuous glucose monitoring (sCGM) system, with respect...
Article
Potential sources of discomfort or stressors associated with an intensive care unit (ICU) stay can be classified as intrinsic or patient-related factors, environmental factors (such as noise and excess of light), and organizational factors. Two approaches facilitate the assessment of ICU-related stressors: first an objective approach by measuring p...
Article
To develop and validate the IPREA (Inconforts des Patients de REAnimation) questionnaire for the assessment of discomfort perceived by patients related to their intensive care unit (ICU) stay. This was a two step-study comprising a phase of item generation conducted in one ICU and a phase of psychometric evaluation during a multicenter prospective...
Article
Since the publication of the first Leuven study highlighting the association between tight glycemic control and reduced mortality in surgical intensive care patients, many protocols have been developed and used in clinical practice. Recent multicentrer studies that did not find the positive results of the landmark study lead us to question the meth...
Article
Full-text available
Potential discomfort sources or stressors associated with an hospitalization in the intensive care unit (ICU) can be classified as intrinsic or patient-related factors, environmental factors (such as noise and excess of light) and organizational factors. There are two approaches to assess ICU-related stressors: an objective approach by measuring ph...
Article
Since the publication of the first Leuven study highlighting the association between tight glycemic control and reduced mortality in surgical intensive care patients, many protocols have been developed and used in clinical practice. Recent multicentrer studies that did not find the positive results of the landmark study lead us to question the meth...
Article
Full-text available
The report by Chase and coworkers in the previous issue of Critical Care describes the implementation into clinical practice of the Specialized Relative Insulin Nutrition Table (SPRINT) for tight glycaemic control in critically ill patients. SPRINT is a simple, wheel-based system that modulates both insulin rate and nutritional inputs. It achieved...
Article
To evaluate a new silver-impregnated multi-lumen central venous catheter for reducing catheter-related colonization in intensive care patients. Multicenter, prospective, randomized, controlled clinical study. Ten adult intensive care units (multidisciplinary, medical and surgical, university and nonuniversity hospitals) in eight institutions. A tot...
Article
We report the case of a patient with a febrile acute respiratory failure associated with alveolar opacities localized in the left upper lobe on chest-X-ray. Diagnosis was related to pulmonary embolism with overflow pulmonary edema. Complete recovery was obtained after mechanical ventilation, anticoagulation and a short course of intra venous dobuta...
Article
TRAUMA is the leading cause of death among young people in developed countries. 1 Because up to 80% of trauma deaths occur during the first 24 h after trauma, 1 early resuscitation and rapid assessment of trauma lesions are of paramount importance to improving the prognosis. Among traumatic lesions, pulmonary contusion is frequent but has not been...
Article
We report a case of acute respiratory failure due to Toxoplasma gondii mimicking pneumocystosis in an AIDS patient. Empirical antibiotic therapy with cotrimoxazole is discussed. Active research and identification of pathogens with adapted laboratory tests is mandatory.