Xavier Capdevila

French Institute of Health and Medical Research | Inserm · Department of Anesthesiology and Critical care , Lapeyronuie University hospital

Background: The management of perioperative iron deficiency is a component of the concept of patient blood management. The objective of this study was to update French data on the prevalence of iron deficiency in patients scheduled for major surgery. Methods: The CARENFER PBM study was a prospective cross-sectional study in 46 centers specialize...

Background: The most common long-term symptoms of critically ill COVID-19 patients are fatigue, dyspnea and mental confusion. Adequate monitoring of long-term morbidity, mainly analyzing the activities of daily life (ADLs), allows better patient management after hospital discharge. The aim was to report long-term ADL evolution in critically ill CO...

Background: Assessment of anemia and iron deficiency before surgery is pivotal for patient blood management (PBM), but few data on current practices are available in the French context. The objective of this study was to describe anemia and iron deficiency management and blood transfusion use in surgical departments in France. Methods: This was...

Background: Reducing perioperative anxiety and controlling pain in children are essential to optimise recovery and outcomes for both children and their parents. By acting on sensory and affective modulation of anxiety and pain, hypnosis is widely used in medical care, especially in anaesthesia. This randomised controlled clinical trial was designe...

Background: Non-invasive ventilation (NIV) and oxygen therapy (high-flow nasal oxygen [HFNO] or standard oxygen) following extubation have never been compared in critically ill patients with obesity. We aimed to compare NIV (alternating with HFNO or standard oxygen) and oxygen therapy (HFNO or standard oxygen) following extubation of critically il...

Background The bicaval drainage under veno-venous extracorporeal membrane oxygenation (VV ECMO) was compared in present experimental study to the inferior caval drainage in terms of systemic oxygenation. Method Two mathematical models were built to simulate the inferior vena cava-to-right atrium (IVC → RA) route and the bicaval drainage-to-right a...

Background Sedation of ventilated critically ill trauma patients requires high doses of opioids and hypnotics. We aimed to compare the consumption of opioids and hypnotics, and patient outcomes using sedation with or without continuous regional analgesia (CRA). Methods Multiple trauma-ventilated patients were included. The patients were randomized...

Background: The aim of this study was to assess the interdependence of extracorporeal blood flow (Qec) and gas flow (GF) in predicting CO2 removal and reduction of minute mechanical ventilation under extracorporeal respiratory support. Methods: All patients who benefited from V-V ECMO and high-flow ECCO2 R in our intensive care unit over a perio...

Objectives Severe trauma patients are at higher risk of infection and often exposed to antibiotics which could favor acquisition of antimicrobial resistance. In this study, we aimed to assess prevalence, acquisition and factors associated with acquisition of extended-spectrum cephalosporin-resistant Gram-negative bacteria (ESCR-GNB) in severe traum...

Background The optimal approach to improving patient experience and analgesia after ambulatory orthopaedic surgery remains unclear. Methods This multicentre, randomised clinical trial compared single-injection nerve block analgesia with home delivery of continuous nerve block analgesia by remote-controlled electronic pump. The primary outcome was...

Résumé La prise en charge des fractures du col du fémur est un sujet de santé publique qui concerne une population âgée à prédominance féminine. La mortalité augmente lorsque le délai de prise en charge est supérieur à 24 heures chez les patients sans co-morbidités. Les patients souffrant de co-morbidités peuvent être identifiés avec des scores spé...

(Anaesthesia. 2021;76:777–784. [Epub January 11, 2021]) Spinal anesthesia is the standard technique for patients undergoing cesarean delivery (CD). Bupivacaine has been a mainstay for spinal anesthesia for decades due to its minimal onset time and extended duration of motor and sensory block. There are disadvantages, however, such as some effect va...

Background and Aims WALANT (Wide Awake Local Anesthesia No Tourniquet) might be a real alternative to the axillary block (BAX) in hand and wrist ambulatory surgery. Using long-acting local anesthetics, it could prolong postoperative analgesia while preserving motor skills. We hypothesize that WALANT using lidocaine/bupivacaine and dexamethasone pro...

Background and Aims Intra-operative hypotension (IOH) is associated with a significant increase in post-operative morbidity and mortality in non-cardiac surgery. There’s no consensus concerning the best anesthesia technique for traumatic leg and ankle surgery. We hypothesize that peripheral nerve blocks (PNB) decrease the risk of intra-operative hy...

Background and Aims Ultrasound-guided lumbar plexus block(ULPB) can be performed using two approaches: a parasagital (PSA) or transversal(TA). The PSA and TA have been described targeting the location of transverse process of the 4th lumbar vertebra (L4). A higher approach may promote organ puncture complication. We hypothised that TA ULPB might pr...

Study objective After surgery, patients reported the delay in receiving help as the primary factor for poorly controlled pain. This study aimed to compare the effectiveness of patient management through two communication modalities: remote transmission (RT) versus bedside control (BC). We hypothesized that using remote technology for pump programmi...

Background The aim of present study was to assess the association between acute post-traumatic atrophy (APTMA) determined on psoas computed tomography [CT] scan and the duration of mechanical ventilation and outcomes in severe trauma patients. Methods A retrospective analysis of severe trauma patients (Injury Severity Score [ISS], >15) hospitalize...

Background: Optimal decarboxylation dose under extracorporeal respiratory support to ensure sufficient reduction of mechanical ventilation stress remains unclear and understudied. The aim of this study was to assess the interdependence of blood flow (BF) and gas flow (GF) in predicting CO2 removal and mechanical ventilation reduction (MVR) under ex...

Introduction: Cardiovascular accidents are the world's leading cause of death. A good quality cardiopulmonary resuscitation (CPR) can reduce cardiac arrest-associated mortality. This study aims to test the coaching system of a wearable glove, providing instructions during out-of-hospital CPR. Materials and Methods: We performed a single-blind, cont...

Background: The relationship between the driving pressure of the respiratory system (ΔPrs) under mechanical ventilation and worse outcome has never been studied specifically in chest trauma patients. The objective of the present study was to assess in cases of chest trauma the relationship between ΔPrs and severity of acute respiratory distress syn...

Background COVID-19 is a multisystem disease complicated by respiratory failure requiring sustanined mechanical ventilation (MV). Prolongued oro-tracheal intubation is associated to an increased risk of dysphagia and bronchial aspiration. Purpose of this study was to investigate swallowing disorders in critically ill COVID-19 patients. Material an...

Background In the pandemic scenario, critically ill COVID-19 patients’ management presented an increased workload for Intensive Care Unit (ICU) nursing staff, particularly during pronation maneuvers, with high risk of complications. In this contest, some authors described an increase in complications incidence after pronation. An ICU Pronation Team...

Background There are few studies on the safety and respiratory consequences of the use of a skeletal traction (ST) device in the management of femoral shaft fractures with damage control orthopaedics (DCO) strategy, particularly in cases of prolonged use. The aim of this study was to assess the influence of ST compared with an external fixator (EF)...

Background: The worldwide pandemic situation forced many hospitals to improve COVID-19 management. In this scenario, the Swiss Academy of Medical Sciences (SAMW/ASSM) organized guidelines based on expert opinion to identify Do-Not-Resuscitate (DNR) patients, which often need palliative care (PC) due to a large symptoms burden. In our specialized CO...

Background Temporary transition from the half-seated position (HSP) to the lying position (LyP) is often associated with an increase in intracranial pressure (ICP) during management of patients with severe traumatic brain injury (TBI). This study was designed to assess the impact of the temporary LyP on cerebral perfusion and oxygenation in cases o...

Background There is heterogeneity in the names and anatomical descriptions of regional anesthetic techniques. This may have adverse consequences on education, research, and implementation into clinical practice. We aimed to produce standardized nomenclature for abdominal wall, paraspinal, and chest wall regional anesthetic techniques. Methods We c...

Background: A Hip fracture in the intermediate-risk elderly patient is common and associated with a high rate of postoperative morbidity and mortality. There is a lack of consensus on the optimal anaesthetic technique but there is a clear association between intraoperative hypotension and postoperative morbidity and mortality. We aimed to compare...

Study objective: Ultrasound guidance does not eliminate the risk of intraneural injection, which must be avoided during PNB. Combining ultrasound guidance (USG), nerve stimulation (NS), and injection pressure monitoring is advocated to prevent nerve injury during PNB. We hypothesized that combining patient-tailored dynamic NS and real-time pressur...

Objectives: During the pandemic, critically ill COVID-19 patients' management presented an increased workload for Intensive Care Unit (ICU) nursing staff, particularly during pronation maneuvers, with high risk of complications. In this scenario, a support during pronation by the ICU Physiotherapy Team was introduced. Research methodology: Retrospe...

Background: Our aim was to describe the characteristics of vertebral fractures, the presence of associated injuries, and clinical status within the first days in a severe trauma population. Methods: All patients with severe trauma admitted to our level 1 trauma center between January 2015 and December 2018 with a vertebral fracture were analyzed...

Background and objectives Anesthesiologists and hospitals are increasingly confronted with costs associated with the complications of Peripheral Nerve Blocks (PNB) procedures. The objective of our study was to identify the incidence of the main adverse events associated with regional anesthesia, particularly during anesthetic PNB, and to evaluate t...

Background Pain management is important for ensuring early mobilization after hip arthroplasty; however, the optimal components remain controversial. Recently, the quadratus lumborum block has been proposed as an analgesic option. The current study tested the hypothesis that the posterior quadratus lumborum block combined with multimodal analgesia...

Posterior Lumbar plexus block (PLPB) combined with an ipsilateral sacral plexus block is a valuable anaesthetic technique in patients undergoing hip fracture surgery. PLPB is performed through the acoustic window of the lumbar ultrasound trident and the position of the needle tip, before injection of LA, was confirmed by observing quadriceps femori...

Background The sensory innervation of the lower jaw mainly depends on the third root of the trigeminal nerve, the mandibular nerve (V3). The aim of this single-center, prospective, randomized, double-blind, placebo-controlled study was to evaluate the effectiveness of bilateral V3 block for postoperative analgesia management in mandibular osteotomi...

Background The performance of each veno‐venous extracorporeal membrane oxygenation (vv‐ECMO) configuration is determined by the anatomic context and cannula position. Methods A mathematical model was built considering bicaval specificities to simulate femoro‐jugular configuration. The main parameters to define were cardiac output (QC), blood flow...

Association of independent lung ventilation (ILV) and veno-venous extracorporeal membrane oxygenation (vv-ECMO) may be life-saving therapy in cases of refractory hypoxemia. We report the case of a trauma patient affected by asymmetric hypoxemic lung contusions and massive air leak managed by association of ILV and vv-ECMO. This combined strategy al...

Background Behavioral pain scales are recommended to assess postoperative pain for children who are too young to use self‐report tools. Their main limitation is underestimation of pain in the days following an intervention. Although relevant, facial expression is not used in daily clinical practice. This prospective study aimed to assess the validi...

Hyperbaric bupivacaine spinal anaesthesia remains the gold standard for elective caesarean section, but the resultant clinical effects can be unpredictable. Hyperbaric prilocaine induces shorter motor block but has not previously been studied in the obstetric spinal anaesthesia setting. We aimed to compare duration of motor block after spinal anaes...

Background There is heterogeneity in the names and anatomical descriptions of regional anesthetic techniques. This may have adverse consequences on education, research, and implementation into clinical practice. We aimed to produce standardized nomenclature for abdominal wall, paraspinal, and chest wall regional anesthetic techniques. Methods We co...

Background: Nerve damage can occur after peripheral nerve block (PNB). Ultrasound guidance does not eliminate the risk of intraneural injection or nerve injury. Combining nerve stimulation and injection pressure (IP) monitoring with ultrasound guidance has been suggested to optimize needle tip location in PNB. In this prospective observational stu...

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 fo...

Résumé Le Patient Blood Management (PBM) a pour objectif de prendre en charge l’anémie et le saignement des patients opérés en évitant au maximum le recours à la transfusion par la mise en place d’une stratégie intégrée, multimodale et multidisciplinaire. La mise en œuvre clinique du PBM repose ainsi sur trois piliers : l’optimisation de la masse s...

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...

Background Postoperative pain after pediatric cardiac surgery is usually treated with intravenous opioids. Recently, the focus has been on postoperative regional analgesia with the introduction of ultrasound-guided erector spinae plane blocks (ESPBs). We hypothesized that bilateral ESPB with a programmed intermittent bolus (PIB) regimen decreases p...

Background The incidence of unintentional intraneural injection while performing peripheral nerve block has been estimated to be 15% under real-time ultrasound guidance. Injection pressure increase may detect an intraneural injection. Real-time injection pressure changes throughout an entire nerve block procedure in relationship with needle tip loc...

Background Nerve damage can occur after ultrasound guided peripheral nerve block (PNB). Injection pressure monitoring could improve the safety of PNB. The aim was to analyse parameters affecting pressure measurements during PNB. Methods The flow characteristics of needles connected to a pressure-sensing device were evaluated. Needles were placed u...

Background: "Macintosh"-videolaryngoscopes (VLs) are VLs that allow both direct and indirect laryngoscopy for intubation. We describe the decision-making and implementation-processes that our hospital used regarding the choice of device. We compared the performances of 4 Macintosh-VLs both in direct and indirect laryngoscopy. Methods: A quality-...

BACKGROUND In orthopedic surgery, a patient blood management program (PBM) has been proposed to reduce blood transfusion. The aim of this observational study was to assess, within a PBM, the specific efficacy of preoperative erythropoietin (EPO). STUDY DESIGN AND METHODS In a single hospital, 723 patients undergoing elective primary hip or knee ar...

Résumé Le genou est innervé par les nerfs fémoral, obturateur et sciatique, qui se divisent en une dizaine de rameaux à destinée articulaire. La chirurgie du genou est une chirurgie fonctionnelle pourvoyeuse de douleurs aiguës postopératoires sévères et de douleurs chroniques. L’analgésie balancée, insuffisante pour assurer seule la réhabilitation...

Background Pelvic and retroperitoneal hematoma (PRH) in case of pelvic fracture may lead to early hemorrhagic shock. Quantifying PRH remains challenging in clinical practice. The goal of this study was to determine the statistical association between a semi-quantitative scoring system for PRH assessed with computed tomography (CT) and transfusion n...

Introduction: Available short-acting intrathecal anesthetic agents (chloroprocaine and prilocaine) offer an alternative to general anesthesia for short-duration surgical procedures, especially ambulatory surgeries. Factors determining the choice of anesthesia for short-duration procedures have not been previously identified. Methods: This observ...

Introduction: This observational study was designed to assess the use of spinal anesthesia with chloroprocaine in the context of ambulatory surgery. Methods: A prospective, multicenter, observational study was carried out among 33 private or public centers between May 2014 and January 2015 and adult patients, scheduled for a short ambulatory sur...

Résumé Les blocs compartimentaux du dos sont une alternative aux blocs centraux pour l’analgésie après chirurgie du tronc. Les principaux blocs compartimentaux décrits dans cet article sont : le bloc rétro-lamaire, le bloc des érecteurs, le bloc intercostal/paraspinal et le bloc à mi distance entre le processus transverse et la plèvre. Les termes b...

Background and Objective The temporal bone window (TBW) for transcranial Doppler (TCD) often fails to insonate the anterior cerebral artery (ACA). The frontal bone window (FBW) has never been evaluated in intensive care units (ICU). The main objective was to determine the ability of the FBW to assess ACA velocities in critically ill patients. Meth...

Continuous peripheral nerve blocks refer to a local anesthetic solution administered via perineurally placed catheters in an effort to extend the benefits of a single-shot peripheral nerve block. They offer several advantages in the postoperative period including excellent analgesia, reduced opioid consumption and associated side effects, enhanced...

Background: Ultrasound-guided axillary block is widely used in daily practice for upper limb orthopedic surgery. A simple, safe, efficacious and time-saving technique is mandatory to optimize surgical turnover and costs. In this perspective, we compared, in a randomized, single-blinded study, a standardized perifascial technique and the selective...

Background: We report a rare case of anaerobic vertebral osteomyelitis associated with surgical tracheotomy which has never been reported to the best of our knowledge. Case presentation: A healthy 39-year-old man was admitted to intensive care for a severe brain trauma injury where a surgical tracheotomy was performed. He was discharged to a reh...

Résumé Cette revue présente l’organisation générale de la Société française d’anesthésie et de réanimation (SFAR), qui a pour but de promouvoir la sécurité des patients à travers l’enseignement et la recherche en anesthésie-réanimation.

this guideline is an update of the guidelines published by the French Society of Anesthesiology (SFAR-) in 2003. This new guidelines clarify the evolution of the regional anesthesia in 2018.