Frédéric Adnet

Université Paris 13 Nord, Вильтанез, Île-de-France, France

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Publications (321)1039.29 Total impact

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    ABSTRACT: The number of cases of acquired angioedema related to angiotensin converting enzyme inhibitors induced (ACEI-AAE) is on the increase, with a potential concomitant increase in life-threatening attacks of laryngeal edema. Our objective was to determine the main characteristics of ACEI-AAE attacks and, in doing so, the factors associated with likelihood of hospital admission from the emergency department (ED) after a visit for an attack. A prospective, multicenter, observational study (April 2012–December 2014) was conducted in EDs of 4 French hospitals in collaboration with emergency services (SAMU 93) and a reference center for bradykinin-mediated angioedema. For each patient presenting with an attack, emergency physicians collected demographic and clinical presentation data, treatments, and clinical course. They recorded time intervals from symptom onset to ED arrival and to treatment decision, from ED arrival to specific treatment with plasma-derived C1-inhibitor (C1-INH) or icatibant, and from specific treatment to onset of symptom relief. Attacks requiring hospital admission were compared with those not requiring admission. Sixty-two eligible patients with ACEI-AAE (56% men, median age 63 years) were included. Symptom relief occurred significantly earlier in patients receiving specific treatment than in untreated patients (0.5 [0.5–1.0] versus 3.9 [2.5–7.0] hours; P < 0.0001). Even though icatibant was injected more promptly than plasma-derived C1-INH, there, however, was no significant difference in median time to onset of symptom relief between the 2 drugs (0.5 [0.5–1.3] versus 0.5 [0.4–1.0] hours for C1-INH and icatibant, respectively, P = 0.49). Of the 62 patients, 27 (44%) were admitted to hospital from the ED. In multivariate analysis, laryngeal involvement and progressive swelling at ED arrival were independently associated with admission (Odds ratio [95% confidence interval] = 6.2 [1.3–28.2] and 5.9 [1.3–26.5], respectively). A favorable course was observed in all patients. Three patients (5%) experienced a recurrence after angiotensin-converting enzyme inhibitor discontinuation after a median follow-up of 18 (11–30) months. Two severity criteria—laryngeal edema and the progression of the edema—were independent factors associated with likelihood of hospital admission. Appropriate specific treatments (plasma-derived C1-INH or icatibant) should be available in EDs to prevent possibly life-threatening complications.
    No preview · Article · Nov 2015 · Medicine

  • No preview · Article · Oct 2015 · European Journal of Emergency Medicine
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    ABSTRACT: Background Presentation to the Ethics Committee (EC) is a part of the medical research regulatory framework. Therefore, French Society of Emergency Medicine (SFMU) searched for this information during the submission of abstract for the annual SFMU’s congress. The aim was to assess the responses of authors submitting an abstract to the SFMU requesting EC approval. Procedure An investigator, ignoring the purpose of the study, reviews all abstracts presented to the congress in 2014. However, two other investigators had reviewed the abstract again. We collected: if the study was prospective or retrospective, if randomization or none, with intervention or none and EC approval, none or not applicable. We analyzed the EC evaluation essential for the randomized studies, recommended for all prospective studies and/or with intervention on a patient or staff member and possible for other cases. Results Six hundred and ninety-five submissions were reviewed. 159 (23%) were multicentric studies. EC approval was issued for 105 (15%) abstracts and 528 (76%) were considered as not applicable. Authors considered the EC advice of 13 (59%) randomized studies, 120 (68%) interventional studies, and 277 (72%) prospective studies as not applicable. Conclusion The EC advice was insufficiently requested, even for randomized studies. This underreporting is a highrisk judicial factor for research structures. A reminder about the regulatory framework and an increased supervision from the SFMU would be necessary.
    No preview · Article · Sep 2015 · Annales Francaises de Medecine d'Urgence
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    ABSTRACT: Introduction Proposition of assistance and alarm for elderly and dependent people are increasing. Calls from these companies have become numerous in emergencydispatching center (SAMU). The purpose of this study was to characterize these calls. Methods The study was conducted in a French medical call center (SAMU 93) over a two years period (2010-2012). Calls from assistance and alarm companies have been systematically reviewed. Age and gender of the patient, medical decision, second level requirement, transfer to the hospital and death before arriving at the hospital were investigated. The opportunity to have a direct contact with the patient and the reason for call were assessed by further analysis. Proportion of patients treated and transported by a mobile intensive care unit was used as primary endpoint. Results Two thousand two hundred ninety-one calls from assistance and alarm have been analyzed. The average was 3.0 calls per day. These calls come from 1,677 (73 %) women. The median age was 83 (75-88) years. First aid rescue vehicle was sent in 1,507 (68 %) cases. Other decisions were sending a light ambulance (251 cases, 11 %), a doctor (227 cases, 10 %), a mobile intensive care unit (108 cases, 5 %), giving medical advice (106 cases, 5 %) and other decisions (92 cases, 4 %). In 81 (4 %) cases, a higher-level intervention was required. Finally, 1,900 (83 %) patients were transported to the hospital. In 48 (2 %) cases, medical transfer was required. Five patients (0.2 %) died before arrival at the hospital. Of 116 calls specifically analyzed, a direct contact with the patient was not possible in 67 (58 %) cases. Conclusion Calls from assistance and alarm companies were frequent. They were related to very elderly patients. Direct contact with the patient was rare. Intensive medical care was exceptionally required. A direct call of the patient to the emergency-dispatching center (SAMU) would be preferable. It would contribute to optimize the management and orientation of the patient.
    No preview · Article · Jul 2015 · Annales Francaises de Medecine d'Urgence
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    Full-text · Conference Paper · Jul 2015
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    Full-text · Article · Jun 2015 · La Presse Médicale

  • No preview · Article · May 2015 · La Presse Médicale
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    ABSTRACT: Acute attacks of hereditary angioedema are characterized by recurrent localized edema. These attacks can be life threatening and are associated with substantial morbidity and mortality. To determine factors associated with hospital admission of patients with an acute attack of hereditary angioedema presenting at the emergency department. This was a multicenter prospective observational study of consecutive patients (January 2011 through December 2013) experiencing an acute hereditary angioedema attack and presenting at the emergency department at 1 of 4 French reference centers for bradykinin-mediated angioedema. Attacks requiring hospital admission were compared with those not requiring admission. Of 57 attacks in 29 patients, 17 (30%) led to hospital admission. In multivariate analysis, laryngeal and facial involvements were associated with hospital admission (odds ratio 18.6, 95% confidence interval 3.9-88; odds ratio 7.7, 95% confidence interval 1.4-43.4, respectively). Self-injection of icatibant at home was associated with non-admission (odds ratio 0.06, 95% confidence interval 0.01-0.61). The course was favorable in all 57 cases. No upper airway management was required. Most patients attended the emergency department because they were running out of medication and did not know that emergency treatment could be self-administered. Risk factors associated with hospital admission were laryngeal and facial involvement, whereas self-injection of icatibant was associated with a return home. Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · Apr 2015 · Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology
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    ABSTRACT: Introduction En France, la régulation médicale est une étape fondamentale dans la gestion des urgences préhospitalières. Il existe très peu de données concernant son enseignement durant le cursus universitaire. L’objectif de ce travail était de réaliser un état des lieux de l’enseignement à la régulation médicale au cours du Diplôme d’Études Spécialisées Complémentaires de Médecine d’Urgence d’Île-de-France (DESC-MU IDF) à la recherche d’éventuelles carences et de pistes d’amélioration pour cette formation. Méthode Il s’agit d’une étude observationnelle, prospective, déclarative, réalisée entre mars et avril 2014, à partir d’un questionnaire s’adressant aux médecins titulaires du DESC-MU IDF des promotions 2012 et 2013. Résultats Les questionnaires ont été envoyés à 177 médecins. Sur les soixante-sept médecins participants (38 %), neuf (13 % [IC95 %:7-24]) ont reçu une formation théorique et pratique à la régulation médicale. Soixante-douze pour cent estiment avoir ressenti des carences de formation au cours de leurs premières régulations en tant que médecin senior. Plus de neuf médecins sur dix recommandent une formation théorique et pratique de la régulation médicale. Conclusion Ce travail met en évidence les carences existantes dans la formation à la régulation médicale au cours de la formation du DESC-MU IDF. Ces résultats doivent faire discuter l’enseignement au niveau de chaque site de stage ainsi qu’au niveau régional, tant sur le plan théorique que pratique.
    No preview · Article · Mar 2015 · Annales Francaises de Medecine d'Urgence
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    ABSTRACT: Bradykinin-mediated angioedema is characterized by transient attacks of localized edema of subcutaneous or submucosal tissues and can be life-threatening when involving the upper airways. The aim of this study was to determine the features of acute attacks that might be associated with admission to an ICU. We carried out a retrospective, multicenter, observational study in consecutive patients attending one of six reference centers in France for acute bradykinin-mediated angioedema attacks. Patients had been hospitalized for an acute episode at least once previously. Acute attacks requiring ICU admission were compared with acute attacks that had not required ICU admission. Overall, 118 acute attacks in 31 patients were analyzed (10 patients with hereditary angioedema, 19 patients with angiotensin-converting enzyme inhibitor-induced angioedema, and two patients with acquired C1-inhibitor deficiency angioedema). In multivariate analysis, upper airway involvement, corticosteroid, and C1-inhibitor concentrate administration were associated with ICU admission. Seven episodes (18%) needed airway protection. The evolution was favorable in 38 of 39 attacks warranting ICU admission: patients were able to get out of the service (mean ICU stay 4±5 days). One death was observed by asphyxiation because of laryngeal swelling. Upper airway involvement is an independent risk factor for ICU admission. Corticosteroid use, which is an ineffective treatment, and C1-inhibitor concentrate use are factors for ICU admission. The presence of upper airway involvement should be a warning signal that the attack may be severe.
    No preview · Article · Feb 2015 · European Journal of Emergency Medicine

  • No preview · Article · Feb 2015 · Annales de cardiologie et d'angeiologie

  • No preview · Article · Jan 2015 · La Presse Médicale

  • No preview · Article · Jan 2015
  • F. Lapostolle · M. Galinski · F. Adnet
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    ABSTRACT: L’intubation trachéale en urgence est associée à une plus forte incidence de difficultés. Cette difficulté accrue est elle-même associée à une augmentation des complications et de la mortalité. La recherche de critères prédictifs d’une intubation difficile est plus délicate en urgence et moins pertinente. Le recours à des alternatives à l’intubation orotrachéale, l’optimisation de la procédure et l’utilisation de procédures spécifiques limitent la survenue et les conséquences d’une intubation difficile. Le choix d’un matériel, une organisation et un entraînement éprouvés permettent de réduire les conséquences d’un cas d’intubation difficile, prévue ou non. Les nouveaux dispositifs de « vidéoscopie » semblent supérieurs aux techniques classiques d’intubation, en particulier en cas d’intubation difficile. Ils devront très certainement trouver leur place dans les prochains algorithmes de prise en charge des intubations difficiles en urgence, voire, plus globalement, des intubations en urgence. Chaque structure potentiellement confrontée à l’intubation en urgence devrait d’ores et déjà s’interroger sur son choix de matériel et sa stratégie.
    No preview · Article · Jan 2015 · Réanimation
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    ABSTRACT: The optimal therapeutic strategy for patients with high-risk acute coronary syndrome without ST-segment elevation (NSTE-ACS) remains unclear. Our aim was to compare the effectiveness of an early invasive strategy and a delayed invasive strategy in the management of high-risk NSTE-ACS patients. This randomized clinical trial in a primarily pre-hospital setting enrolled patients with chest pain, electrocardiographic criteria for an NSTE-ACS, and at least one criterion of severity (ESC criterion or TIMI score >5). Patients were randomized to either an early invasive strategy (tirofiban infusion and coronary angiography within 6h) or delayed invasive strategy (as per guidelines and physician discretion; coronary angiography within 6h was not advised). The primary endpoint was the cumulative incidence of deaths, myocardial infarctions, or urgent revascularizations at 30days of follow-up. Secondary endpoints were failure of delayed management, length of hospital stay and long-term mortality. Between January 2007 and February 2010, 170 patients were enrolled. The cumulative incidence of adverse outcomes was significantly lower for early invasive than delayed management (2% [95% CI 0-9] vs. 24% [95% CI 16-35], p<10(-4)). Delayed management failed in 24% of cases. The length of hospital stay was significantly shorter in patients undergoing angioplasty or treated with tirofiban within 6h (p=0.0003). Long-term mortality was 16% in both arms after a median follow-up of 4.1years. An early invasive strategy reduced major adverse cardiac events in patients with high-risk NSTE-ACS. Early angiography or tirofiban (GP IIb/IIIa inhibitor) infusion proved necessary in a quarter of patients assigned to delayed management. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    No preview · Article · Dec 2014 · International Journal of Cardiology
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    ABSTRACT: To evaluate the long-term prognostic effect of resting heart rate (HR) at index myocardial infarction (MI) and during the first year after MI among 1-year survivors. The community-based cohort consisted of 1571 patients hospitalized with an incident MI from January 1, 1983, through December 31, 2007, in Olmsted County, Minnesota, who were in sinus rhythm at index MI and had HR measurements on electrocardiography at index and during the first year after MI. Outcomes were all-cause and cardiovascular deaths. During a median follow-up of 7.0 years, 627 deaths and 311 cardiovascular deaths occurred. Using patients with HRs of 60/min or less as the referent, this study found that long-term all-cause mortality risk increased progressively with increasing HR at index (hazard ratio, 1.62; 95% CI, 1.25-2.09) and even more with increasing HR during the first year after MI (hazard ratio, 2.16; 95% CI, 1.64-2.84) for patients with HRs greater than 90/min, adjusting for clinical characteristics and β-blocker use. Similar results were observed for cardiovascular mortality (adjusted hazard ratio, 1.66; 95% CI, 1.14-2.42; and adjusted hazard ratio, 1.93; 95% CI, 1.27-2.94; for HR at index and within 1 year after MI, respectively). These data from a large MI community cohort indicate that HR is a strong predictor of long-term all-cause and cardiovascular mortality not only at initial presentation of MI but also during the first year of follow-up. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
    Preview · Article · Dec 2014 · Mayo Clinic Proceedings

  • No preview · Article · Sep 2014 · Annales Françaises d Anesthésie et de Réanimation
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    ABSTRACT: Purpose: To evaluate the psychological consequences among family members given the option to be present during the CPR of a relative, compared with those not routinely offered the option. Methods: Prospective, cluster-randomized, controlled trial involving 15 prehospital emergency medical services units in France, comparing systematic offer for a relative to witness CPR with the traditional practice among 570 family members. Main outcome measure was 1-year assessment included proportion suffering post-traumatic stress disorder (PTSD), anxiety and depression symptoms, and/or complicated grief. Results: Among the 570 family members [intention to treat (ITT) population], 408 (72%) were evaluated at 1 year. In the ITT population (N = 570), family members had PTSD-related symptoms significantly more frequently in the control group than in the intervention group [adjusted odds ratio, 1.8; 95% confidence interval (CI) 1.1-3.0; P = 0.02] as did family members to whom physicians did not propose witnessing CPR [adjusted odds ratio, 1.7; 95% CI 1.1-2.6; P = 0.02]. In the observed cases population (N = 408), the proportion of family members experiencing a major depressive episode was significantly higher in the control group (31 vs. 23%; P = 0.02) and among family members to whom physicians did not propose the opportunity to witness CPR (31 vs. 24%; P = 0.03). The presence of complicated grief was significantly greater in the control group (36 vs. 21%; P = 0.005) and among family members to whom physicians did not propose the opportunity to witness resuscitation (37 vs. 23%; P = 0.003). Conclusions: At 1 year after the event, psychological benefits persist for those family members offered the possibility to witness the CPR of a relative in cardiac arrest.
    No preview · Article · May 2014 · Intensive Care Medicine

  • No preview · Article · May 2014 · Resuscitation
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    ABSTRACT: Chest pain frequently prompts emergency medical services (EMS) call-outs. Early management of acute coronary syndrome (ACS) cases is crucial, but there is still controversy over the relevance of pain severity as a diagnostic criterion. The aim of this study was to determine whether there is a relationship between the severity of chest pain at the time of out-of-hospital emergency care and diagnosis of acute myocardial infarction (AMI). This was a subsidiary analysis of prehospital data collated prospectively by EMS in a large suburb. It concerned patients with chest pain taken to hospital by a mobile intensive care unit. Pain was rated on EMS arrival using a visual analog, numeric or verbal rating scale and classified on severe or not severe according to the pain score. A diagnosis of AMI was confirmed or ruled out on the basis of 2 plasma troponin measurements and/or coronary angiography results. Among the cohort of 2,279 patients included, 234 were suitable for analysis, of which 109 (47%) were diagnosed with AMI. The rate of severe pain on EMS arrival was not significantly different between AMI patients and no myocardial infarction patients (49% [95% CI 40 to 58] and 43% [34 to 52], respectively; P = 0.3; odds ratio 1.3 [0.8 - 2.3] after adjustment for age and gender). In our out-of-hospital emergency setting, the severity of chest pain was not a useful diagnostic criterion for AMI.
    No preview · Article · Mar 2014 · Pain Practice

Publication Stats

4k Citations
1,039.29 Total Impact Points

Institutions

  • 2006-2015
    • Université Paris 13 Nord
      Вильтанез, Île-de-France, France
  • 2012
    • Centre Hospitalier Marc Jacquet
      Melun, Île-de-France, France
  • 2011
    • Emergency medical services Chile
      CiudadSantiago, Santiago Metropolitan, Chile
    • Centre Hospitalier Universitaire de Dijon
      Dijon, Bourgogne, France
  • 2009-2011
    • Hôpital Avicenne – Hôpitaux Universitaires Paris-Seine-Saint-Denis
      Bobigny, Île-de-France, France
    • Hospital de Urgencia de Sergipe
      Aracaju, Sergipe, Brazil
  • 2008-2011
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France