F Leclerc

Université du Droit et de la Santé Lille 2, Lille, Nord-Pas-de-Calais, France

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Publications (337)782.56 Total impact

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    ABSTRACT: Recently, propranolol was suggested to prevent hyperlactatemia in a child with hypovolemic shock through β-adrenergic blockade. Though it is a known inhibitor of glycolysis, propranolol, outside this observation, has never been reported to fully protect against lactate overproduction. On the other hand, literature evidence exists for a cross-talk between β-adrenergic receptors (protein targets of propranolol) and δ-opioid receptor. In this literature context, it is hypothesized here that anti-diarrheic racecadotril (a pro-drug of thiorphan, an inhibitor of enkephalinases), which, in the cited observation, was co-administered with propranolol, might have facilitated the β-blocker-driven inhibition of glycolysis and resulting lactate production. The opioid-facilitated β-adrenergic blockade would be essentially additivity or even synergism putatively existing between antagonism of β-adrenergic receptors and agonism of δ-opioid receptor in lowering cellular cAMP and dependent functions.
    No preview · Article · Oct 2015 · Pharmaceuticals
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    ABSTRACT: Introduction: Daily or serial evaluation of multiple organ dysfunction syndrome (MODS) scores may provide useful information. We aimed to validate the daily (d) PELOD-2 score using the set of seven days proposed with the previous version of the score. Methods: In all consecutive patients admitted to nine pediatric intensive care units (PICUs) we prospectively measured the dPELOD-2 score at day 1, 2, 5, 8, 12, 16, and 18. PICU mortality was used as the outcome dependent variable. The discriminant power of the dPELOD-2 scores was estimated using the area under the ROC curve and the calibration using the Hosmer-Lemeshow chi-square test. We used a logistic regression to investigate the relationship between the dPELOD-2 scores and outcome, and between the change in PELOD-2 score from day 1 and outcome. Results: We included 3669 patients (median age 15.5 months, mortality rate 6.1%, median length of PICU stay 3 days). Median dPELOD-2 scores were significantly higher in nonsurvivors than in survivors (p < 0.0001). The dPELOD-2 score was available at least at day 2 in 2057 patients: among the 796 patients without MODS on day 1, 186 (23.3%) acquired the syndrome during their PICU stay (mortality 4.9% vs. 0.3% among the 610 who did not; p < 0.0001). Among the 1261 patients with MODS on day 1, the syndrome worsened in 157 (12.4%) and remained unchanged or improved in 1104 (87.6%) (mortality 22.9% vs. 6.6%; p < 0.0001). The AUC of the dPELOD-2 scores ranged from 0.75 (95% CI: 0.67-0.83) to 0.89 (95% CI: 0.86-0.91). The calibration was good with a chi-square test between 13.5 (p = 0.06) and 0.9 (p = 0.99). The PELOD-2 score on day 1 was a significant prognostic factor; the serial evaluation of the change in the dPELOD-2 score from day1, adjusted for baseline value, demonstrated a significant odds ratio of death for each of the 7 days. Conclusion: This study suggests that the progression of the severity of organ dysfunctions can be evaluated by measuring the dPELOD-2 score during a set of 7 days in PICU, providing useful information on outcome in critically ill children. Its external validation would be useful.
    Preview · Article · Sep 2015 · Critical care (London, England)
  • F. Leclerc · C. Le Reun · J. Naud · S. Leteurtre
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    ABSTRACT: Pediatric severe sepsis is frequent and remains associated with high mortality and morbidity rates and important costs. It is mainly observed in immunodeficient children and those with comorbidities or admitted in pediatric intensive care units (PICUs). In the USA, around 100,000 children with severe sepsis are admitted each year in pediatric emergency departments. The main causes of sepsis are respiratory and genito-urinary infections or bacteremia.Management is based on the recommendations of the surviving sepsis campaign updated in 2012, with the aim of decreasing mortality of sepsis with rapid diagnosis and treatment. An expert consensus has provided new definitions of pediatric sepsis in 2002. Diagnosis of septic shock is clinical: suspected infection with signs of poor perfusion, while arterial blood pressure may be normal. Pre-hospital management may need intervention of the SAMU/SMUR. Beside oxygen, initial resuscitation consists in rapid fluid administration and antibiotics, whose efficacy on mortality have been proven. Further management must be conducted in PICU, guided by echography-Doppler that allows to adapt treatment (inotrope and vaso-active drugs, fluids) according to the hemodynamic profile (warm/cold shock). Other treatments are discussed in case of initial resuscitation failure (corticoids, vasopressin, hemofiltration, extracorporeal membrane oxygenation…). Several studies reported a poor adherence to the recommendations, others, with quality improvement interventions have demonstrated improved compliance to the elements of treatment with a better outcome. © 2015, Société française de médecine d'urgence and Springer-Verlag France.
    No preview · Article · May 2015 · Annales Francaises de Medecine d'Urgence
  • Francis Leclerc
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    ABSTRACT: Mechanical ventilation is the principal technology that justifies admission of critically ill patients in intensive care units (children (www.picanet.org.uk) as well as adults (Metnitz et al. 2009)). In a recent survey conducted in France in 2002 by the French Ministry of Health that included 40 intensive care units for children (30 caring for neonates and children (N-PICUs), 10 caring only for children older than 1 month (PICUs)), and 24 units completed the item “mechanical ventilation” for a total of 14,147 admissions. In total, 47 % of patients were mechanically ventilated (30 % with a duration of more than 48 h) (Table 1.1. data not published). This percentage is close to the 40-45 % reported in the Netherlands (Dahlem et al. 2003; Kneyber et al. 2008) and 49 % in Italy (Wolfler et al. 2010) and higher than that recently reported in 16 US pediatric ICUs (30 %; range 20-64 %) (Khemani et al. 2009), but lower than the 73 % reported in the UK for 2008 (www.picanet.org.uk). Also, respiratory diseases or dysfunction represent the most frequent cause of ICU admission either for neonates (Janota et al. 2008) or children (Johnston et al. 2004; Leteurtre et al. 2003). In a recent report of 51,386 children with organ dysfunction, respiratory dysfunction was the strongest predictor of death and was associated with a greater than 5-fold increase in length of stay and a 25-fold increase in total charges (Johnston et al. 2004). Finally, number of ventilation-free days is utilized as an outcome measure in clinical trials assuming that the decrease in duration of ventilation benefits the patient and reduces treatment costs (Curley and Zimmerman 2005).
    No preview · Article · Jan 2015
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    ABSTRACT: Lactate production results from anaerobic glycolysis. This pathway is recruited physiologically during intense and sustained muscular contractions. Hyperlactatemia may develop when tissue oxygenation is jeopardized such as in shock, its absence having been, however, sometimes reported in sepsis in which interactions between infectious agents and the organism's cells might blunt or disrupt hyperlactatemia development. During the course of acute rotavirus gastroenteritis, a 9-month-old girl developed severe dehydration (capillary-refill time, 5 s) leading to hypovolemic shock without signs of sepsis and with hypotension at 62/21mmHg Surprisingly, the child failed to develop hyperlactatemia during shock. An etiologic search to understand why hyperlactatemia did not occur revealed that this patient had been receiving propranolol since the age of four months for the treatment of a Cyrano hemangioma. Via its inhibitory action on β-adrenergic receptors, propranolol antagonizes the stimulation of glycolysis by catecholamines, which may be rationally proposed to have contributed to preventing hyperlactatemia during hypovolemic shock in this patient. Mechanisms by which propranolol can mediate this antihyperlactatemia action are further illustrated and discussed. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
    No preview · Article · Dec 2014 · Archives de Pédiatrie

  • No preview · Article · Dec 2014
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    ABSTRACT: Background and aim Multiple organ dysfunction, not respiratory failure, is the major cause of death in children with ALI or ARDS. This study was undertaken to estimate the predictive value of death of the non-respiratory Paediatric Logistic Organ Dysfunction (PELOD)-2 (NRespPELOD-2) in children with acute respiratory failure (ARF). Methods Analysis of the database of the recently published PELOD-2. All consecutive children (excluding neonates) admitted to 9 PICU in France and Belgium (June 2006–October 2007) and having ARF. We prospectively collected data on variables considered for the PELOD-2 score during PICU stay: days 1, 2, 5, 8, 12, 16 and 18, plus PICU discharge. For each variable of the PELOD-2 score, the most abnormal value observed during time points was collected. Outcome was vital status at PICU discharge. We used AUCs to estimate the discrimination and Hosmer-Lemeshow goodness-of-fit tests to estimate calibration of the PELOD-2 and the NRespPELOD-2 scores, with correction for the optimism bias using a bootstrap resampling method. Results We included 1572 patients (median age: 20.6 months; mortality: 9.5%). Discrimination of the PELOD-2 and the NRespPELOD-2 was excellent (AUC=0.93 and 0.92, respectively) and calibration was good (p = 0.45 and 0.27, respectively). The four NResp organ dysfunctions were closely related to the risk of mortality (p < 0.001). Conclusions Our study demonstrates that the NRespPELOD-2 score of the entire PICU stay is highly predictive of death in children with ARF of whom 94.3% were invasively ventilated. It could represent the non-respiratory organ failure definition tool claimed by the international experts on paediatric ARDS.
    Preview · Article · Oct 2014 · Archives of Disease in Childhood
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    ABSTRACT: The aim of this investigation was to conduct a comprehensive examination of communication between parents and health care professionals (HCPs) in the pediatric intensive care unit (PICU). A secondary analysis was performed on data from 3 previous qualitative studies, which included 30 physicians, 37 nurses, and 38 parents in France and Quebec (Canada). All three studies examined a mix of cases where children either survived or died. All data referring to communication between parents (and patients when applicable) and HCPs were examined to identity themes that related to communication. Thematic categories for parents and HCPs were developed. Three interrelated dimensions of communication were identified: (1) informational communication, (2) relational communication, and (3) communication and parental coping. Specific themes were identified for each of these 3 dimensions in relation to parental concerns as well as HCP concerns. This investigation builds on prior research by advancing a comprehensive analysis of PICU communication that includes (a) cases where life-sustaining treatments were withdrawn or withheld as well as cases where they were maintained, (b) data from HCPs as well as parents, and (c) investigations conducted in 4 different sites. An evidence-informed conceptual framework is proposed for PICU communication between parents and HCPs. We also outline priorities for the development of practice, education, and research.
    No preview · Article · Jul 2014 · Journal of Child Health Care
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    ABSTRACT: Multiple organ dysfunction, not respiratory failure, is the major cause of death in children with acute lung injury or acute respiratory distress syndrome. This study was undertaken to estimate the predictive value of death of the nonrespiratory Pediatric Logistic Organ Dysfunction-2 in children with acute respiratory failure.
    No preview · Article · Jun 2014 · Pediatric Critical Care Medicine

  • No preview · Article · May 2014 · Pediatric Critical Care Medicine
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    ABSTRACT: Background: About 10% of pediatric patients with invasive pneumococcal disease (IPD) die from the disease. Some primary immunodeficiencies (PIDs) are known to confer predisposition to IPD. However, a systematic search for these PIDs has never been carried out in children presenting with IPD. Methods: We prospectively identified pediatric cases of IPD requiring hospitalization between 2005 and 2011 in 28 pediatric wards throughout France. IPD was defined as a positive pneumococcal culture, polymerase chain reaction result, and/or soluble antigen detection at a normally sterile site. The immunological assessment included abdominal ultrasound, whole-blood counts and smears, determinations of plasma immunoglobulin and complement levels, and the evaluation of proinflammatory cytokines. Results: We included 163 children with IPD (male-to-female ratio, 1.3; median age, 13 months). Seventeen children had recurrent IPD. Meningitis was the most frequent type of infection (87%); other infections included pleuropneumonitis, isolated bloodstream infection, osteomyelitis, endocarditis, and mastoiditis. One patient with recurrent meningitis had a congenital cerebrospinal fluid fistula. The results of immunological explorations were abnormal in 26 children (16%), and a PID was identified in 17 patients (10%), including 1 case of MyD88 deficiency, 3 of complement fraction C2 or C3 deficiencies, 1 of isolated congenital asplenia, and 2 of Bruton disease (X-linked agammaglobulinemia). The proportion of PIDs was much higher in children aged >2 years than in younger children (26% vs 3%; P < .001). Conclusions: Children with IPD should undergo immunological investigations, particularly those aged >2 years, as PIDs may be discovered in up to 26% of cases.
    Full-text · Article · Apr 2014 · Clinical Infectious Diseases
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    ABSTRACT: La formation en réanimation pédiatrique relève d’un véritable défi en raison de l’augmentation croissante des connaissances et des compétences, de la relative rareté des situations critiques et de la diminution de présence des étudiants auprès des patients. La simulation est une des méthodes pédagogiques pouvant améliorer notablement cette formation. Elle est par ailleurs éthiquement nécessaire, tout particulièrement pour l’apprentissage des gestes techniques. La simulation permet en outre une approche efficace de l’étude des facteurs humains, des comportements d’équipe et de la communication avec l’enfant et sa famille, d’importance capitale en réanimation pédiatrique. Elle concerne aussi bien la formation initiale que la formation continue et doit envisager à terme sa place dans l’évaluation objective des professionnels. La mise en place de réseaux de recherche sur la simulation en santé apparaît aujourd’hui indispensable pour permettre l’amélioration des pratiques et de la sécurité des soins.
    No preview · Article · Nov 2013 · Réanimation
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    ABSTRACT: Septic shock is frequent in children and is associated with high mortality and morbidity rates. Early recognition of severe sepsis improve outcome. Shock index (SI), ratio of heart rate (HR) and systolic blood pressure (SBP), may be a good noninvasive measure of hemodynamic instability that has been poorly studied in children. The aim of the study was to explore the usefulness of SI as an early index of prognosis for septic shock in children. The study was retrospective and performed in 1 pediatric intensive care unit at a university hospital. The following specific data were collected at 0, 1, 2, 4, and 6 hours after admission: HR and SBP for SI calculation and lactate concentration. Patients were divided into 2 groups according to their outcome (death/survival). A total of 146 children admitted with septic shock between January 2000 and April 2010 were included. Shock index was significantly different between survivors and nonsurvivors at 0, 4, and 6 hours after admission (P = 0.02, P = 0.03, and P = 0.008, respectively). Age-adjusted SIs were different between survivors and nonsurvivors at 0 and 6 hours, with a relative risk of death at these time points of 1.85 (1.04-3.26) (P = 0.03) and 2.17 (1.18-3.96) (P = 0.01), respectively. Moreover, an abnormal SI both at admission and at 6 hours was predictive of death with relative risk of 1.36 (1.05-1.76). In our population of children with septic shock, SI was a clinically relevant and easily calculated predictor of mortality. It could be a better measure of hemodynamic status than HR and SBP alone, allowing for the early recognition of severe sepsis.
    No preview · Article · Sep 2013 · Pediatric emergency care
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    ABSTRACT: Background and aims Organ dysfunction scores, such as the PEdiatric Logistic Organ Dysfunction (PELOD) score developed in 1999, are primarily designed to describe the severity of organ dysfunction. This study was undertaken to update and improve the PELOD score, using a larger and more recent dataset. Methods We did a prospective, observational, multicentre cohort study in nine French-speaking multidisciplinary, tertiary-care PICUs of university-affiliated hospitals between June 2006 and October 2007. We collected data on variables considered for the PELOD-2 score at seven time-points after PICU admission: days 1, 2, 5, 8, 12, 16 and 18, plus PICU discharge. For each variable, the most abnormal value observed during each time point was collected. Identification of the best variable cutoffs was performed using bivariate, multivariate regressions and bootstrap process. The outcome was vital status at PICU discharge. We used area under receiver operating characteristic curve (AUC) to evaluate discrimination and Hosmer-Lemeshow goodness-of-fit test to evaluate calibration. Results We included 3671 consecutive patients (median age 15.5 months IQR 2.2–70.7). Mortality rate was 6.0% (222 deaths). Discrimination and calibration of the PELOD 2 score were 0.93 and 9.31 (p=0.317) respectively. Conclusion We developed and validated the PELOD-2 score, which allows assessment of the severity of cases of MODS in PICU with a continuous scale. The score will be in the public domain, which means that it can be freely used in clinical trials.
    Preview · Article · Jun 2013 · Critical care medicine
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    Miriam Santschi · Francis Leclerc
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    ABSTRACT: Background Pediatric sepsis represents an important cause of mortality in pediatric intensive care units (PICU). Although adherence to published guidelines for the management of severe sepsis patients is known to lower mortality, actual adherence to these recommendations is low. The aim of this study was to describe the initial management of pediatric patients with severe sepsis, as well as to describe the main barriers to the adherence to current guidelines on management of these patients. Methods A survey using a case scenario to assess the management of a child with severe sepsis was designed and sent out to all PICU medical directors of the 20 institutions member of the “Réseau Mère- Enfant de la Francophonie”. Participants were asked to describe in detail the usual management of these patients in their institution with regard to investigations, fluid and catecholamine management, intubation, and specific treatments. Participants were also asked to identify the main barriers to the application of the Surviving Sepsis Campaign guidelines in their center. Results Twelve PICU medical directors answered the survey. Only two elements of the severe sepsis bundles had a low stated compliance rate: “maintain adequate central venous pressure” and “glycemic control” had a stated compliance of 8% and 25% respectively. All other elements of the bundles had a reported compliance of over 90%. Furthermore, the most important barriers to the adherence to Surviving Sepsis Campaign guidelines were the unavailability of continuous central venous oxygen saturation (ScvO2) monitoring and the absence of a locally written protocol. Conclusions In this survey, pediatric intensivists reported high adherence to the current recommendations in the management of pediatric severe sepsis regarding antibiotic administration, rapid fluid resuscitation, and administration of catecholamines and steroids, if needed. Technical difficulties in obtaining continuous ScvO2 monitoring and absence of a locally written protocol were the main barriers to the uniform application of current guidelines. We believe that the development of locally written protocols and of specialized teams could add to the achievement of the goal that every child in sepsis should be treated according to the latest evidence to heighten his chances of survival.
    Preview · Article · Mar 2013 · Annals of Intensive Care
  • F. Leclerc · A. Botte · M.-E. Lampin · R. Cremer · S. Leteurtre

    No preview · Article · Sep 2012

  • No preview · Article · Jun 2012 · Neurophysiologie Clinique/Clinical Neurophysiology
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    Yvon Riou · Wissem Chaari · Stéphane Leteurtre · Francis Leclerc
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    ABSTRACT: To evaluate the physiological deadspace/tidal volume ratio (VD/VT) as a predictor of extubation failure in 42 ventilated children (median age: 4.75 years). Extubation readiness was determined using the criteria proposed by the 6th International Consensus Conference on Intensive Care Medicine adapted to children. Non-invasive ventilation (NIV) was used in four patients who developed respiratory failure after extubation; none was reintubated. Children who needed NIV to avoid reintubation had a significantly higher VD/VT ratio than those who were extubated without NIV (p < 0.001). The cut-off value of VD/VT ratio was 0.55 and the area under the receiver operating characteristic curve was 0.86. Our findings confirm the good predictive value of weaning success/failure of the VD/VT ratio and suggest its role for predicting the need for NIV after extubation.
    Preview · Article · May 2012 · Jornal de pediatria
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    ABSTRACT: To test the performance of PIM2 in French-speaking (FS) paediatric intensive care units (PICUs) and its relative performance when recalibrated using data from FS and Great Britain (GB) PICUs of different size. Consecutive admissions to 15 FS (n = 5,602) and 31 GB PICUs (n = 20,693) from June 2006 to October 2007 were included. The recalibrated PIM2 were applied to PICUs of different size within the FS and GB PICUs and between the two groups. PICU size was defined using number of admissions/month. Discrimination and calibration were evaluated using the area under the ROC curve (AUC) and the goodness-of-fit test, respectively. Logistic regression, funnel plots and standardized W scores were performed in the two groups and between different PICU sizes. In FS PICUs, the original PIM2 had good discrimination (AUC = 0.85) and moderate calibration (p = 0.07). The recalibrated PIM2 scores had good calibration in FS (p = 0.33) and moderate calibration in GB (p = 0.06). Calibration was poor when the recalibrated FS PIM2 was applied to GB (p = 0.02) but good when the GB recalibration was applied to the FS (p = 0.36). Using the original PIM2 coefficients, calibration was poor in large units in both groups but improved following recalibration. There were no effects of PICU size on risk-adjusted mortality in GB and a significant effect in the FS PICUs with a minimum risk-adjusted mortality at about 35 admissions/month. The PIM2 score was valid in the FS population. The recalibration based on GB data could be applied to FS PICUs. Such recalibration may facilitate comparisons between countries.
    Full-text · Article · May 2012 · Intensive Care Medicine
  • M E Lampin · J Rousseaux · A Botte · A Sadik · R Cremer · F Leclerc
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    ABSTRACT: To report our 10 year experience with noradrenaline use in children with septic shock focusing on doses, routes of administration and complications. Retrospective single-centre review of children with septic shock who received noradrenaline between 2000 and 2010. We identified 144 children with septic shock treated with noradrenaline, in 22% as the first-line drug. The median volume resuscitation before vasoactive agent administration was 50 mL/kg interquartile range [IQR: 30-70]. Mean doses of noradrenaline ranged from 0.5 ± 0.4 μg/kg per min (starting dose) to 2.5 ± 2.2 μg/kg per min (maximum dose). Noradrenaline was administered via peripheral venous access or intra-osseous route in 19% of cases for a median duration of 3 h [IQR: 2-4] without any adverse effects. The use of noradrenaline increased over the study period. Mortality rate was 45% with a significant decrease over the study period. Adverse effects included arrhythmia in two children and hypertension in eight children. None of these arrhythmias required treatment and hypertension resolved with the noradrenaline dose reduction. Higher doses of noradrenaline than those suggested in the literature may be necessary to reverse hypotension and hypoperfusion. The use of noradrenaline through peripheral venous access or intra-osseous route was safe, without any adverse effects.
    No preview · Article · May 2012 · Acta Paediatrica

Publication Stats

3k Citations
782.56 Total Impact Points

Institutions

  • 2010-2015
    • Université du Droit et de la Santé Lille 2
      Lille, Nord-Pas-de-Calais, France
    • Lille Catholic University
      Lille, Nord-Pas-de-Calais, France
  • 1992-2014
    • University of Lille Nord de France
      Lille, Nord-Pas-de-Calais, France
  • 1992-2012
    • Centre Hospitalier Régional Universitaire de Lille
      • • Division of Neurology
      • • Division of Neonatal Medicine
      Lille, Nord-Pas-de-Calais, France
  • 2002
    • Centre Oscar Lambret
      Lille, Nord-Pas-de-Calais, France
  • 1989-2000
    • CHRU de Strasbourg
      Strasburg, Alsace, France
    • Institut Pasteur de Lille
      Lille, Nord-Pas-de-Calais, France