F Nicolas

Centre Hospitalier Universitaire de Nantes, Naoned, Pays de la Loire, France

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Publications (171)187.96 Total impact

  • E Bironneau · W Martineau · F Nicolas
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    ABSTRACT: Objective: Psychiatric symptoms are often observed in the intensive care unit (ICU). The most frequently described patterns are those of depression, anxiety and delirium. Their correct diagnosis is generally difficult in the ICU as psychiatrists are rarely permanently present, and because we lack precise scales or tools to describe these patients. The aim of this study was to prospectively assess the psychiatric state of all patients admitted in our ICU during 18 months and to design valid tools to detect psychiatric disorders in ICU patients.
    No preview · Article · Dec 1998 · Réanimation Urgences
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    ABSTRACT: Acinetobacter baumannii is an important opportunistic pathogen that is rapidly evolving toward multidrug resistance and is involved in various nosocomial infections that are often severe. It is difficult to prevent A. baumannii infection because A. baumannii is ubiquitous and the epidemiology of the infections it causes is complex. To study the epidemiology of A. baumannii infections and assess the relation between fluoroquinolone use and the persistence of multidrug-resistant clones. Three case-control studies and a retrospective cohort study. A 20-bed medical and surgical intensive care unit. Acinetobacter baumannii was isolated from 45 patients in urine (31%), the lower respiratory tract (26.7%), wounds (17.8%), blood (11.1%), skin (6.7%), cerebrospinal fluid (4.4%), and sinus specimens (2.2%). One death was due to A. baumannii infection. Antimicrobial resistance pattern and molecular typing were used to characterize isolates. The incidence of A. baumannii infection and the use of fluoroquinolones were calculated annually. Initially, 28 patients developed A. baumannii infection. Eleven isolates had the same antimicrobial susceptibility profile, genotypic profile, or both (epidemic cases), and 17 were heterogeneous (endemic cases). A surgical procedure done in an emergency operating room was the main risk factor for epidemic cases, whereas previous receipt of a fluoroquinolone was the only risk factor for endemic cases. The opening of a new operating room combined with the restriction of fluoroquinolone use contributed to a transitory reduction in the incidence of infection. When a third epidemiologic study was done, previous receipt of a fluoroquinolone was again an independent risk factor and a parallel was seen between the amount of intravenous fluoroquinolones prescribed and the incidence of endemic infection. Epidemic infections coexisted with endemic infections favored by the selection pressure of intravenous fluoroquinolones.
    No preview · Article · Sep 1998 · Annals of internal medicine
  • E. Bironneau · W. Martineau · F. Nicolas
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    ABSTRACT: Objective: Psychiatric symptoms are often observed in the intensive care unit (ICU). The most frequently described patterns are those of depression, anxiety and delirium. Their correct diagnosis is generally difficult in the ICU as psychiatrists are rarely permanently present, and because we lack precise scales or tools to describe these patients. The aim of this study was to prospectively assess the psychiatric state of all patients admitted in our ICU during 18 months and to design valid tools to detect psychiatric disorders in ICU patients. Methods: Fifty-six signs used in the diagnosis of depression, anxiety and/or delirium were proposed to the clinician in charge of every admitted patient in our ICU during the study period: a total of 1,010 patients were enrolled. Results: Fifty/1,010 (5.3%) of patients presented a psychiatric disorder. Ten to 15 tests turned out to be useful, and were selected for the diagnosis of each syndrome. The ICU somatic disorder was significantly more severe, and the length of stay of patients was significantly longer in those with a psychiatric diagnosis than the others. In general, depression and anxiety appear 15 days after admission in the ICU. Discussion and conclusion: Psychiatric disorders appear generally after 2 weeks in the more severe ICU patients. Simple clinical signs can be used in the ICU to detect anxiety, depression and delirium.
    No preview · Article · Jan 1998 · Réanimation Urgences
  • P. Le Conte · F Nicolas · C Adjou · J M N'Guyen · E Billaud · P Moreau
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    ABSTRACT: To compare the tolerance and the cost of three replacement fluids in plasmapheresis: albumin 4% alone, albumin 4% + dextran 40, or albumin 4% + hydroxyethylstarch 6%. A one center randomized, cross-over, comparative study designed to explore the tolerance and the colloid oncotic pressure in patients undergoing plasmapheresis. 225 plasmapheresis procedures were performed in 27 patients. Hemodynamic tolerance was good in the three treatment groups. Serum protein concentration after plasmapheresis was significantly lower in the albumin + hydroxyethylstarch group, followed by albumin + dextran 40, versus albumin alone. Colloid oncotic pressure before and after exchange was similar in the three groups. The clinical use of 25-30% of hydroxyethylstarch 6% or dextran 40 with albumin 4% was clinically well tolerated and associated with a 12% decrease of the cost of substitution solutions.
    No preview · Article · Apr 1997 · Intensive Care Medicine
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    D Hurel · P Loirat · F Saulnier · F Nicolas · F Brivet
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    ABSTRACT: To assess the quality of life of intensive care survivors 6 months after discharge. Multicenter prospective study. Medical-surgical intensive care units (ICUs) of four French university hospitals. Among the 589 patients admitted to the four ICUs between 1 January and 31 March 1989, 329 were investigated. A generic scale assessing health-related quality of life, the Nottingham Health Profile (NHP), a satisfaction scale, the Perceived Quality of Life scale (PQOL) and a questionnaire on professional status were sent by mail 6 months after discharge. Data concerning age, severity of acute illness (assessed by the Simplified Acute Physiology Score) and main diagnosis were recorded. A total of 223 questionnaires (67.8 %) were analysable. The professional status remained unchanged in 79.7% of the patients, despite a significant (p < 0.01) increase (15.3 vs 22.1%) in sick leave. Quality of life, assessed with NHP, was fair (50th percentile = 0.73 on a 0 to 1 scale), whereas satisfaction measured by PQOL was lower (50th percentile = 0.61). Both scales correlated well (z = 9.853; p = 0.0001) but with a large dispersion. The NHP scale showed a severe reduction in energy, sleep and emotional reactions, whereas social isolation, pain and physical handicap were infrequent. Family support was rated with the PQOL score as very good, whereas dissatisfaction concerning recreational and professional activities was expressed. Subsequent sick leave was associated with a poor quality of life (p < 0.05). Quality of life was mainly a function of the diagnosis, not of age and severity of illness: patients admitted for suicide attempt or chronic obstructive pulmonary disease fared poorly. Quality of life measured with a health-related quality of life scale and a satisfaction scale 6 months after an ICU stay depended on the admission diagnosis. Different dimensions of quality of life were variably affected.
    Full-text · Article · Apr 1997 · Intensive Care Medicine
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    ABSTRACT: Because it remained controversial, the use of selective digestive decontamination (SDD) in patients in the intensive care unit (ICU) was chosen as the topic of the first European Consensus Conference in Intensive Care Medicine (ECCICM) in December, 1991. The Consensus Bureau decided to assess the impact of this conference 2 years afterwards. For this purpose, a questionnaire was sent to the members of the European Society of Intensive Care Medicine, the Societé de Réanimation de Langue Française and the Societé Française d'Anesthesie et Réanimation before the conference. The recommendations following the conference discouraged the systematic use of SDD in ventilated patients and urged the monitoring of bacterial resistance and adapting antibiotics to epidemiology of the units. Two years after the conference, the same questionnaire was sent to those physicians who had responded to the first one. Eighteen percent used SDD for all ventilated patients and 17% remain users after 2 years. Among the occasional (32%) or continual (17%) users of SDD, the regimens used were mostly intravenous cefotaxime (60% of systemic antibiotics) and a topical combination of polymixin E, tobramycin, and amphotericin B (62% of overall topical combinations). The antibiotics used were unchanged after 2 years in almost all cases. In conclusion, the short-term impact of the Consensus Conference on SDD in ICU patients has been poor. This may be related to the continuing insufficiency of strong, definite data regarding the impact of this technique upon mortality and the theoretical risk of resistance to antibiotics, thus allowing physicians to stick to their policies until there is new evidence.
    No preview · Article · Oct 1996 · Intensive Care Medicine
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    ABSTRACT: In 1989 a Consensus Conference (CC) organized by the French Society of Intensive Care Medicine recommended to replace the use of albumin, in the treatment of hypovolemia, by less costly products which had been proven to be as efficient as albumin. The aim of our study was to compare the efficacity of three ways of decreasing the prescription of albumin, according to these recommendations: namely the diffusion of the conclusions of the CC to all the potential prescribers, the action of an 'opinion leader' firmly convinced that a restriction policy was necessary, and a medical audit. The impact of the diffusion of the consensus statement, alone, was weak. But the action of an opinion leader obtained a decrease of 88% of the use of albumin, a medical audit, repeated four times, decreased by 75% the use of albumin, and a unique medical audit obtained a decrease of 58%. The conclusions confirm that the recommendations of a Consensus Conference have to be accompanied with other measures. The action of an opinion leader seems to be the most efficacious. If the circumstances are not favourable to this method, an audit, and especially a repetitive audit, appears as a good means to implement the recommendations and to obtain a reduction of medical expenditure, without a reduction of the quality of care, which is the specific aim of medical monitoring of care expenditure.
    No preview · Article · May 1996 · Journal d'Economie Medicale
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    ABSTRACT: The aim of this study was to evaluate three factors able to influence the impact of a Consensus Development Conference (CC). The CC tested was the IVth CC organized by the Société de Réanimation de Langue Françaisc (SRLF). A questionnaire sent to all members of the two most interested medical societies (Société de Réanimation de Langue Française and Société Française d'Anesthésie et de Réanimation) aimed at investigating 1- doctors awareness about the existence of the CC, 2- their knowledge of the content of jury's recommendations, 3- their agreement with the recommendations. Ninety one p. 100 of the doctors were aware of the CC. The most efficacious ways for delivering the information were the direct mailing of the consensus statement (59 p. 100 of the answers) and the complete publication of the consensus statement in the review published by the SRLF (57,5 p. 100). The content of the tested recommendations was known by 66 p. 100 to 93 p. 100 of the doctors. The agreement with the recommendations varied from 66,5 p. 100 to 93 p. 100 for 75 p. 100 of the tested recommendations. The survey of the awareness of the consensus statement and of the agreement with the recommendations in representative samples of the most concerned physicians or specialists could help for analyzing the real impact of a CC, for detecting the reasons for insufficient impact and for improving the final results of a CC. Some findings could be applied in a preventive way to further CC.
    No preview · Article · Dec 1995 · Réanimation Urgences
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    ABSTRACT: An appropriate number of nurses to achieve required care is essential to develop quality of care in ICUs. The PRN system, developed in Canada, is based on the daily collection of 249 parameters speaded over 118 nursing acts and classified in eight groups. Each PRN point requires five minutes of work. This system is valid, but too time consuming to be routinely collected. The aim of this study was to elaborate a specific and simplified index to evaluate nurse workload in ICUs. A multicentric study (25 ICUs, 735 patients) collected daily detailed PRN data from admission to discharge in 103 patients (mean age 56 ± 17 years ; length of stay 9 ± 12,3 days ; SAPS 13 ± 7). On the whole, 732 daily PRN indexes have been calculated and detailed (mean index value : 124 ± 47,8). A simplified index (icuPRN) has been elaborated : acts were selected and weighted by using a principal components analysis and a multiple regression analysis. The simplified index (icuPRN) is based on 35 acts speaded over the eight nursing groups. The nurse workload measured by icuPRN is strongly correlated with workload obtained with the PRN system (r = 0,98, p < 10−6). icuPRN provides an accurate assessment of the nurse workload in ICU by using a limited number of nursing acts. It is simpler than the PRN system and could be routinely used. However, this index has to be prospectively validated among another sample of ICUs patients, particularly in specialized units.
    No preview · Article · Dec 1995 · Réanimation Urgences
  • P. Le Conte · A. Kenzi · G. Potel · D. Baron · D. Villers · F. Nicolas
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    ABSTRACT: In the last few years, the incidence of severe infection due to Streptococcus A has increased, and the mortality remained high. Fourteen patients with streptococcal A septic shock hospitalized in the Intensive Care Unit between 1983 et 1992 have been included in this study. Clinical, hemodynamic and biological features in survival and non-survival patients have been collected and compared. The Fisher's exact test and the Mann-Whitney test have been performed. Six patients have been admitted in the last two years, demonstrating the increasing frequency of this disease. Six patients died (42 p.100) in an average time of 7 hours after admission. The portal of entry was frequently cutaneous or sub-cutaneous: cellulitis (85 p.100) or wound infection (7,5 p.100). A septic shock was always present. In 7 patients the blood culture grew with Streptococcus A, but the 7 other patients had received antibiotics before the blood sample. All patients received adequate antibiotics, and 8 underwent major surgical procedure. A statistically significant difference was found between the two groups of patients on the following features: arterial bicarbonate and leucocytes count. Septic shocks due to Streptococcus A are often rapidly fatal affections. The incidence of this disease in increasing both in litterature and in our patients. The prognosis factors listed above allow to define a high severity group at risk of early death.
    No preview · Article · Dec 1995 · Réanimation Urgences
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    ABSTRACT: Animal study results have suggested a role in sepsis for human interleukin for DAl.a cells/leukemia inhibitory factor (HILDA/LIF). HILDA/LIF and interleukin-6 (IL-6) levels were prospectively studied by serial ELISAs in 34 septic patients. HILDA/LIF was detected in 11 of 34 patients at plasma levels of 100–37,000 pg/mL. Peak HILDA/LIF levels correlated with increased temperature and creatinine and IL-6 and with decreased arterial CO2 (P < .05). Multivariate analysis showed that shock and decreased arterial CO2 accounted for 75% of peak HILDA/LIF plasma variations (R2 = .753). Fatal outcome was most often associated with detectable HILDA/LIF (> 56 pg/mL) and peak IL-6 plasma levels > 850 pg/mL (sensitivity, 83%; specificity, 87%), but both (at respective levels of > 480 and > 850 pg/mL) were associated with fatal outcome. HILDA/LIF was detected in septic patients exhibiting shock, and its levels correlated with higher mortality and shorter survival.
    No preview · Article · Feb 1995 · The Journal of Infectious Diseases
  • D VILLERS · E BIRONNEAU · T VIGIER · F NICOLAS

    No preview · Article · Dec 1994 · Réanimation Urgences
  • F NICOLAS · D VILLERS

    No preview · Article · Dec 1994 · Réanimation Urgences
  • F NICOLAS · P LECONTE · D VILLERS · J RAIMONDEAU
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    ABSTRACT: This study was undertaken to evaluate the prescriptions of albumin (a costly product) and plasma (a potentially contaminating product), by the means of an internal medical audit, in one ICU, after a a Consensus development Conference (CC) and to examine if repeating the audit could orientate the practice of the doctors towards a better adequacy to the guidelines defined in the CC statement. The CC tested was the IVth CC organized by the French Language Society of Intensive Care. The criteria to be used to screen the practice and the standards to be met were defined according to the recommendations of the CC. Actual prescribing practice was then screened in the charts of 50 consecutive patients treated for hypovolemia collected during four periods: the first one, one year after the diffusion of the recommendations of the CC, the other ones over the two following years. In the first period, reflecting the intrinsic impact of the CC, only 20,5 p. 100 of the prescriptions of A and 75 p. 100 of the prescriptions of P were adequate to the criteria. Later on, with the repetition of the audit, the adequacy of the prescriptions of P increased to 90 p. 100 in the 2d and 3d periods and decreased to 75 p. 100 in the 4th period when low risk plasma was available; the adequate prescriptions of A rose to 89 p. 100. We conclude that internal audit may be a convenient means to increase the efficiency of a CC.
    No preview · Article · Dec 1994 · Réanimation Urgences
  • E BIRONNEAU · F NICOLAS

    No preview · Article · Jan 1993 · Réanimation Urgences

  • No preview · Article · Dec 1992 · Réanimation Urgences

  • No preview · Article · Mar 1992 · Intensive Care Medicine
  • F Tasseau · A Chupin · C Pradier · D Villers · D Baron · F Nicolas
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    ABSTRACT: A prospective study was carried out in a medical and surgical ICU to determine the incidence of nosocomial urinary tract infection (NUTI) and to identify the most important risk factors. Over a 6 month period, 180 patients were included. All had an indwelling catheter. Six risk factors were studied: age, sex, illness (medical, surgical, trauma), hospital or extra-hospital origin, simplified acute physiology score and length of bladder catheterization. Forty three patients developed a NUTI. Length of bladder catheterization was the only significant different risk factor in infected and non-infected patients. Kaplan Meir analysis was used to determine time to development of NUTI. The risk rose from 19% for 5 day long catheterization to 50% for 14 day long catheterization.
    No preview · Article · Feb 1990 · Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression
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    ABSTRACT: Legionella longbeachae is a new etiologic agent of legionellosis, and sometimes is isolated in environment. We report the first french case of pneumonia due to L. longbeachae serogroup 1, occured in a immunocompromised patient.
    No preview · Article · Dec 1987 · Médecine et Maladies Infectieuses
  • Françoise Nicolas · Daniel Villers · Lyliane Rozo · Alain Haloun · Annie Bigot

    No preview · Article · Mar 1987 · Critical Care Medicine

Publication Stats

833 Citations
187.96 Total Impact Points

Institutions

  • 1981-1997
    • Centre Hospitalier Universitaire de Nantes
      Naoned, Pays de la Loire, France
  • 1996
    • Ecole Centrale de Nantes
      Naoned, Pays de la Loire, France
  • 1987
    • University of Nantes
      Naoned, Pays de la Loire, France
  • 1983-1985
    • George Washington University
      Washington, Washington, D.C., United States