Yves Cohen

Assistance Publique – Hôpitaux de Paris | AP-HP · Réanimation Médico-chirurgicale

Background Plasmodium malariae is the cause of the rare but severe form of malaria that sometimes affects individuals travelling to malaria-endemic regions. This report presents the unique case of a patient exhibiting severe malaria symptoms caused by P. malariae with no record of recent travel to any malaria-endemic areas. Case presentation An 81...

Purpose: At the critical care level, the flu surveillance system is limited in France, with heterogeneous regional modalities of implementation. Materials, patients and methods: We aimed at assessing the relevance of the Assistance Publique-Hôpitaux de Paris (AP-HP) clinical data warehouse for estimating the burden of the influenza epidemic on m...

Background Reduced mortality at 28 days in patients treated with corticosteroids was demonstrated, but this result was not confirmed by certain large epidemiological studies. Our aim was to determine whether corticosteroids improve the outcomes of our patients hospitalized with COVID-19 pneumonia. Methods Our retrospective, single centre cohort st...

A correction to this paper has been published: https://doi.org/10.1007/s00134-021-06379-1

Background: The efficacy of high flow nasal canula oxygen therapy (HFNO) to prevent invasive mechanical ventilation (IMV) is not well established in severe coronavirus disease 2019 (COVID-19). The aim of this study was to compare the risk of IMV between two strategies of oxygenation (conventional oxygenation and HFNO) in critically ill COVID 19 pa...

The mortality of COVID-19 patients in the intensive care unit (ICU) is influenced by their state at admission. We aimed to model COVID-19 acute respiratory distress syndrome state transitions from ICU admission to day 60 outcome and to evaluate possible prognostic factors. We analyzed a prospective French database that includes critically ill COVID...

PurposeThe primary objective of this study was to investigate the risk of ICU bloodstream infection (BSI) in critically ill COVID-19 patients compared to non-COVID-19 patients. Subsequently, we performed secondary analyses in order to explain the observed results.Methods We conducted a matched case-cohort study, based on prospectively collected dat...

Background: Bacterial infections are frequent triggers for diabetic ketoacidosis. In this context, delayed antibiotic treatment is associated with increased morbidity and mortality. Unnecessary administration of antimicrobial therapy might however, also negatively impact the prognosis. The usefulness of sepsis markers in diabetic ketoacidosis has...

An amendment to this paper has been published and can be accessed via the original article.

Background:. The efficacy of high flow nasal canula oxygen therapy (HFNO) to prevent invasive mechanical ventilation (IMV) is not well established in severe coronavirus disease 2019 (COVID-19). The aim of this study was to compare the risk of intubation between two strategies of oxygenation (conventional oxygenation and HFNO) in critically ill COVI...

Background The coronavirus disease 2019 (Covid-19) outbreak is a main concern and data are lacking concerning risk of 2019 novel coronavirus (SARS-CoV-2) environmental contamination. Objective To identify risk factors of SARS-CoV-2 environmental contamination in Covid-19 patients admitted to the intensive care unit (ICU). Methods Prospective sing...

Aim Early-onset pneumonia (EOP) is a common in-hospital complication in survivors of out-of-hospital cardiac arrest. In this substudy of the CAAM trial, we aimed to compare whether bag mask ventilation (BMV) compared to endotracheal intubation (ETI) performed during cardiopulmonary resuscitation increases the risk of developing EOP. Methods Adult...

The COVID-19 epidemic is believed to have started in late January 2020 in France. Here we report a case of a patient hospitalised in December 2019 in an intensive care unit in a hospital in the north of Paris for haemoptysis with no aetiological diagnosis. RT-PCR was performed retrospectively on the stored respiratory sample and confirmed the diagn...

Background Bacterial infections are frequent triggers for diabetic ketoacidosis. In this context, delayed antibiotic treatment is associated with increase morbidity and mortality. Unnecessary administration of antimicrobial therapy might however also negatively impact the prognosis. The usefulness of traditional sepsis markers in diabetic ketoacido...

Background: With less than one severe case per year in average, Plasmodium vivax is very rarely associated with severe imported malaria in France. Two cases of P. vivax severe malaria occurred in patients with no evident co-morbidity. Interestingly, both cases did not occur at the primary infection but during relapses. Case presentations: Patien...

Background: Acute respiratory failure is the leading reason for intensive care unit (ICU) admission in immunocompromised patients, and the need for invasive mechanical ventilation has become a major clinical endpoint in randomized controlled trials (RCTs). However, data are lacking on whether intubation is an objective criteria that is used unbias...

Objectives: Our objectives were (1) to characterize the distribution of serum potassium levels at ICU admission, (2) to examine the relationship between dyskalemia at ICU admission and occurrence of cardiac events, and (3) to study both the association between dyskalemia at ICU admission and dyskalemia correction by day 2 on 28-day mortality. Des...

Background: With less than one severe case per year in average, P. vivax is very rarely associated with severe imported malaria in France. We report two cases of P. vivax severe malaria in patients with no evident co-morbidity. Interestingly, both cases did not occur at the primary infection but during relapses. Case presentations Patient 1 A 27-y...

Background With less than one severe case per year in average, Plasmodium vivax is very rarely associated with severe imported malaria in France. Two cases of P. vivax severe malaria occurred in patients with no evident co-morbidity. Interestingly, both cases did not occur at the primary infection but during relapses. Case presentations Patient 1:...

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...

Introduction: Acute muscle involvement is an infrequent complication of corticosteroids, characterized by muscle weakness and a rhabdomyolysis, rapidly regressive after withdrawal of corticosteroids. Case report: We report the case of a woman admitted in intensive care unit for acute severe asthma, treated with high doses of methylprednisolone....

Objectives: To investigate the respective impact of ventilator-associated pneumonia and ICU-hospital-acquired pneumonia on the 30-day mortality of ICU patients. Design: Longitudinal prospective studies. Setting: French ICUs. Patients: Patients at risk of ventilator-associated pneumonia and ICU-hospital-acquired pneumonia. Interventions: Th...

Purpose The Doppler-based resistive index (RI) and semi-quantitative evaluation of renal perfusion using color Doppler (SQP) have shown promising results for predicting persistent acute kidney injury (AKI) in preliminary studies. This study aimed at evaluating the performance of RI and SQP to predict short-term renal prognosis in critically ill pat...

We investigated how the initial ventilation/oxygenation management may influence the need for intubation on the coming day in a cohort of immunocompromised patients with acute hypoxemic respiratory failure (ARF). Data from 847 immunocompromised patients with ARF were used to estimate the probability of intubation at day+1 within the first 3 days of...

Objectives: This study in critically ill patients with shock assessed the prognostic value of body weight variations occurring each day from day 3 to day 7 on the 30-day outcome in terms of mortality, occurrence of ventilator-associated pneumonia and of bedsore, and occurrence of length of stay . Design: Retrospective analysis of data. Multivari...

RationaleThe standard of care for patients with acute respiratory distress syndrome (ARDS) has been developed based on studies that usually excluded patients with major comorbidities. Objectives To describe treatments and outcomes according to comorbidities in patients with ARDS admitted to 19 ICUs (1997–2014). Methods Patients were grouped based o...

Background: Extensively drug-resistant bacteria (XDRB) have emerged as a major source of resistance. Hospitalization abroad seems to be the major risk factor associated with carriage, and numerous reports have warned about the risk of in-hospital transmission. However, little is known regarding possible community transmission. Methods: A retrosp...

Importance Airway transplantation could be an option for patients with proximal lung tumor or with end-stage tracheobronchial disease. New methods for airway transplantation remain highly controversial. Objective To establish the feasibility of airway bioengineering using a technique based on the implantation of stented aortic matrices. Design, S...

Objectives: To assess outcomes at hospital discharge and day-120 after intensive care unit (ICU) discharge among patients with solid cancer admitted to ICU and to identify characteristics associated with in-hospital and day-120 after ICU discharge mortalities. Design: International, multicenter, retrospective study. Setting: Five ICUs in Franc...

Background Weaning from mechanical ventilation (MV) may be impeded by the occurrence of agitation. Loxapine has the ability to control agitation without affecting spontaneous ventilation. The aim of this study was to establish whether loxapine would reduce MV weaning duration in agitated patients. Methods We performed a multicentre, double-blind,...

Rationale The impact of prevention strategies and risk factors for early-onset (EOP) versus late-onset (LOP) ventilator-associated pneumonia (VAP) are still debated. Objectives To evaluate, in a multicenter cohort, the risk factors for EOP and LOP, as the evolution of prevention strategies. Methods 7,784 patients with mechanical ventilation (MV)...

Risk factors of early pneumonia using a cut-off at 5 days of mechanical ventilation. (DOCX)

Summary of procedures used for ventilator associated pneumonia prevention in the ICUs of the OUTCOMEREA network. (DOCX)

Objectives: RBC transfusion is often required in patients with sepsis. However, adverse events have been associated with RBC transfusion, raising safety concerns. A randomized controlled trial validated the 7 g/dL threshold, but previously transfused patients were excluded. Cohort studies led to conflicting results and did not handle time-dependen...

Background: To demonstrate the feasibility and safety of weekly high-dose liposomal amphotericin B (L-AmB) (as a pre-emptive antifungal treatment) for 2 weeks in patients with septic shock and Candida colonization. Methods: Pilot, multicentre, open-label, prospective study conducted in seven French ICUs. Non-immunocompromised patients, receiving...

Importance Noninvasive ventilation has been recommended to decrease mortality among immunocompromised patients with hypoxemic acute respiratory failure. However, its effectiveness for this indication remains unclear.Objective To determine whether early noninvasive ventilation improved survival in immunocompromised patients with nonhypercapnic acu...

To the Editor: Carnobacterium spp. are ubiquitous lactic acid bacteria isolated from cold and temperate environments (1). They are present in food including fish, meat, and dairy products. Only C. divergens and C. maltaromaticum (formerly C. piscicola) are found in dairy products (2). Carnobacteria are well known for their ability to produce bacter...

To assess the prognostic impact of transient and persistent acute kidney injury in critically ill patients. Retrospective analysis of prospectively collected patient data SETTING:: Six hospital ICUs. Critically-ill patients with ICU stay longer than three days. None. Assessment of hospital survival with respect to acute kidney injury duration. A to...

Objectives To shed light on the meaning of Aspergillus-positive lower-respiratory-tract samples in non immunocompromized critically ill patients. Methods Multicentre matched case-control (1:5) study. We used prospectively collected data to identify risk factors for Aspergillus-positive specimens, as well as outcomes in Aspergillus-positive patient...

Background and objectives: Increasing experimental evidence suggests that acute respiratory distress syndrome (ARDS) may promote AKI. The primary objective of this study was to assess ARDS as a risk factor for AKI in critically ill patients. Design, setting, participants, & measurements: This was an observational study on a prospective database...

Noninvasive ventilation (NIV) had proven benefits in clinical trials that included selected patients admitted to highly skilled centers. Whether these benefits apply to every patient and in everyday practice deserves appraisal. The aim of the study was to assess the use and outcomes of NIV over the last 15 years. Multicenter database study of criti...

The prognosis of patients with idiopathic pulmonary fibrosis or fibrosing idiopathic nonspecific interstitial pneumonia undergoing invasive mechanical ventilation (MV) for acute respiratory failure is known to be poor. The issue of life support in these patients needs to be reconsidered in light of changes during the past decade in ventilator setti...

Urinary indices have limited effectiveness in separating transient acute kidney injury (AKI) from persistent AKI in ICU patients. Their time-course may vary with the mechanism of AKI. The primary objective of this study was to evaluate the diagnostic value of changes over time of the usual urinary indices in separating transient AKI from persistent...

Background Contrast-enhanced radiographic examinations carry the risk of contrast-associated acute kidney injury (CA-AKI). While CA-AKI is a well-known complication outside the intensive care unit (ICU) setting, data on CA-AKI in ICU patients are scarce. Our aim was to assess the incidence and short-term outcome of CA-AKI in a mixed medical-surgica...

Some patients with the phenotype of severe sepsis may have no overt source of infection or identified pathogen. We investigated whether a procalcitonin-based algorithm influenced antibiotic use in patients with non-microbiologically proven apparent severe sepsis. This multicentre, randomised, controlled, single-blind trial was performed in two para...

Introduction Although renal replacement therapy (RRT) is a common procedure in critically ill patients with acute kidney injury (AKI), its efficacy remains uncertain. Patients who receive RRT usually have higher mortality rates than those who do not. However, many differences exist in severity patterns between patients with and those without RRT an...

Association of renal replacement therapy (RRT) with hospital mortality in multivariate conditional logistic regression according to timing of RRT and maximum RIFLE class reached during the ICU stay (model 2).

Association of renal replacement therapy (RRT) with hospital mortality in multivariate conditional logistic regression (matched patients) according to timing of RRT: results of sensitivity analyses including only patients with a normal serum creatinine value measured on ICU admission.

Baseline characteristics of RIFLE I class patients with and without renal replacement therapy (RRT).

Baseline characteristics of RIFLE R class patients with and without renal replacement therapy (RRT).

Baseline characteristics of RIFLE F class patients with and without renal replacement therapy (RRT).

Lengths of ICU stay after reaching maximum RIFLE class in patients with and without renal replacement therapy (RRT).

Lengths of ICU stay after reaching maximum RIFLE class in nonsurvivors with and without renal replacement therapy (RRT).

Association of renal replacement therapy (RRT) with hospital mortality in multivariate conditional logistic regression according to timing of RRT and maximum RIFLE class reached during the ICU stay (model 1).

The effective management of the respiratory manifestations at the early phase of acute myeloid hemopathies, especially acute myeloid leukaemia, frequently requires a close collaboration between hematologists, pulmonologists and intensivists. Dominated by infectious etiologies, there are however "specific" disease entities that should not be neglect...

The effective management of the respiratory manifestations at the early phase of acute myeloid hemopathies, especially acute myeloid leukaemia, frequently requires a close collaboration between hematologists, pulmonologists and intensivists. Dominated by infectious etiologies, there are however “specific” disease entities that should not be neglect...

We report a case of postsurgical meningitis caused by multiresistant Acinetobacter baumannii successfully treated with high doses of ampicillin/sulbactam combined with rifampicin and fosfomycin.

End-of-life decisions are based on objective and subjective criteria. Previous studies identified substantial subjective biases during end-of-life decision-making. We evaluated whether in-ICU patient's birthday influenced management decisions. We used a case-control design in which patients spending their birthday in the ICU (cases) were matched to...

Although hypothermia is widely accepted as a risk factor for subsequent infection in surgical patients, it has not been well defined in medical patients. We sought to assess the risk of acquiring intensive care unit (ICU)--acquired infection after hypothermia among medical ICU patients. Adults (≥18 years) admitted to French ICUs for at least 2 days...

To determine the occurrence and determinants of temperature abnormalities among patients presenting (<24 hrs) to an intensive care unit and assess their effect on mortality outcome. Inception cohort. French intensive care units participating in the Outcomerea group. Adults (≥ 18 yrs) admitted to an intensive care unit between April 2000 and Novembe...

Acute exacerbation is a substantial cause of death in patients with idiopathic pulmonary fibrosis with poorly described prognostic factors. To review the features associated with acute exacerbation of idiopathic pulmonary fibrosis and assess its prognostic factors. Thirty-seven occurrences of acute exacerbation of idiopathic pulmonary fibrosis were...

Several factors, including diuretic use and sepsis, interfere with the fractional excretion of sodium, which is used to distinguish transient from persistent acute kidney injury (AKI). These factors do not affect the fractional excretion of urea (FeUrea). However, there are conflicting data on the diagnostic accuracy of FeUrea. We conducted an obse...

Although Pseudomonas aeruginosa is a leading pathogen responsible for ventilator-associated pneumonia (VAP), the excess in mortality associated with multi-resistance in patients with P. aeruginosa VAP (PA-VAP), taking into account confounders such as treatment adequacy and prior length of stay in the ICU, has not yet been adequately estimated. A to...

[This corrects the article on p. e13236 in vol. 5.].

Nonsurvivors: Main characteristics and causes of death. Large table to describe the main characteristics and causes of death in the 42 nonsurvivors. (0.10 MB DOC)

Large studies on severe imported malaria in non-endemic industrialized countries are lacking. We sought to describe the clinical spectrum of severe imported malaria in French adults and to identify risk factors for mortality at admission to the intensive care unit. Retrospective review of severe Plasmodium falciparum malaria episodes according to t...