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Jean-Louis Teboul

Glenn Hernández, Gustavo A Ospina-Tascón, Lucas Petri Damiani, Elisa Estenssoro, Arnaldo Dubin, Javier Hurtado, Gilberto Friedman, Ricardo Castro, Leyla Alegría, Jean-Louis Teboul, Maurizio Cecconi, Giorgio Ferri, Manuel Jibaja, Ronald Pairumani, Paula Fernández, Diego Barahona, Vladimir Granda-Luna, Alexandre Biasi Cavalcanti, Jan Bakker
Importance: Abnormal peripheral perfusion after septic shock resuscitation has been associated with organ dysfunction and mortality. The potential role of the clinical assessment of peripheral perfusion as a target during resuscitation in early septic shock has not been established. Objective: To determine if a peripheral perfusion-targeted resuscitation during early septic shock in adults is more effective than a lactate level-targeted resuscitation for reducing mortality...
February 17, 2019: JAMA: the Journal of the American Medical Association
Daniel De Backer, Maurizio Cecconi, Jeffrey Lipman, Flavia Machado, Sheila Nainan Myatra, Marlies Ostermann, Anders Perner, Jean-Louis Teboul, Jean-Louis Vincent, Keith R Walley
While guidelines provide important information on how to approach a patient in septic shock, "many challenges remain" for the management of these patients. In this narrative review, the panel discusses the challenges in identifying the right hemodynamic target, optimization of fluid therapy, selection of vasopressor agents, identification of patients who may benefit from inotropic agents or on the contrary beta-blockade, and use of steroids. The place for microcirculation-targeted therapy is debated as well as the use of alternative techniques (blood purification) and therapies (vitamin C)...
February 11, 2019: Intensive Care Medicine
Thomas W L Scheeren, Jan Bakker, Daniel De Backer, Djillali Annane, Pierre Asfar, E Christiaan Boerma, Maurizio Cecconi, Arnaldo Dubin, Martin W Dünser, Jacques Duranteau, Anthony C Gordon, Olfa Hamzaoui, Glenn Hernández, Marc Leone, Bruno Levy, Claude Martin, Alexandre Mebazaa, Xavier Monnet, Andrea Morelli, Didier Payen, Rupert Pearse, Michael R Pinsky, Peter Radermacher, Daniel Reuter, Bernd Saugel, Yasser Sakr, Mervyn Singer, Pierre Squara, Antoine Vieillard-Baron, Philippe Vignon, Simon T Vistisen, Iwan C C van der Horst, Jean-Louis Vincent, Jean-Louis Teboul
BACKGROUND: Vasopressors are commonly applied to restore and maintain blood pressure in patients with sepsis. We aimed to evaluate the current practice and therapeutic goals regarding vasopressor use in septic shock as a basis for future studies and to provide some recommendations on their use. METHODS: From November 2016 to April 2017, an anonymous web-based survey on the use of vasoactive drugs was accessible to members of the European Society of Intensive Care Medicine (ESICM)...
January 30, 2019: Annals of Intensive Care
Glenn Hernández, Jean-Louis Teboul, Jan Bakker
The original version of this article unfortunately contained a mistake.
January 23, 2019: Intensive Care Medicine
Mathieu Jozwiak, Sandrine Millasseau, Christian Richard, Xavier Monnet, Pablo Mercado, François Dépret, Jean-Emmanuel Alphonsine, Jean-Louis Teboul, Denis Chemla
OBJECTIVES: First, to validate bedside estimates of effective arterial elastance = end-systolic pressure/stroke volume in critically ill patients. Second, to document the added value of effective arterial elastance, which is increasingly used as an index of left ventricular afterload. DESIGN: Prospective study. SETTING: Medical ICU. PATIENTS: Fifty hemodynamically stable and spontaneously breathing patients equipped with a femoral (n = 21) or radial (n = 29) catheter were entered in a "comparison" study...
January 17, 2019: Critical Care Medicine
Alexandra Beurton, Jean-Louis Teboul, Francesco Gavelli, Filipe Andre Gonzalez, Valentina Girotto, Laura Galarza, Nadia Anguel, Christian Richard, Xavier Monnet
BACKGROUND: A passive leg raising (PLR) test is positive if the cardiac index (CI) increased by > 10%, but it requires a direct measurement of CI. On the oxygen saturation plethysmographic signal, the perfusion index (PI) is the ratio between the pulsatile and the non-pulsatile portions. We hypothesised that the changes in PI could predict a positive PLR test and thus preload responsiveness in a totally non-invasive way. METHODS: In patients with acute circulatory failure, we measured PI (Radical-7) and CI (PiCCO2) before and during a PLR test and, if decided, before and after volume expansion (500-mL saline)...
January 18, 2019: Critical Care: the Official Journal of the Critical Care Forum
Glenn Hernández, Jean-Louis Teboul, Jan Bakker
No abstract text is available yet for this article.
January 10, 2019: Intensive Care Medicine
Maurizio Cecconi, Glenn Hernandez, Martin Dunser, Massimo Antonelli, Tim Baker, Jan Bakker, Jacques Duranteau, Sharon Einav, A B Johan Groeneveld, Tim Harris, Sameer Jog, Flavia R Machado, Mervyn Mer, M Ignacio Monge García, Sheila Nainan Myatra, Anders Perner, Jean-Louis Teboul, Jean-Louis Vincent, Daniel De Backer
The original article can be found online.
December 13, 2018: Intensive Care Medicine
Maurizio Cecconi, Glenn Hernandez, Martin Dunser, Massimo Antonelli, Tim Baker, Jan Bakker, Jacques Duranteaum, Sharon Einav, A B Johan Groeneveld, Tim Harris, Sameer Jog, Flavia R Machado, Mervyn Mer, M Ignacio Monge Garcia, Sheila Nainan Myatra, Anders Perner, Jean-Louis Teboul, Jean-Louis Vincent, Daniel De Backer
An international team of experts in the field of fluid resuscitation was invited by the ESICM to form a task force to systematically review the evidence concerning fluid administration using basic monitoring. The work included a particular emphasis on pre-ICU hospital settings and resource-limited settings. The work focused on four main questions: (1) What is the role of clinical assessment to guide fluid resuscitation in shock? (2) What basic monitoring is required to perform and interpret a fluid challenge? (3) What defines a fluid challenge in terms of fluid type, ranges of volume, and rate of administration? (4) What are the safety endpoints during a fluid challenge? The expert panel found insufficient evidence to provide recommendations according to the GRADE system, and was only able to make recommendations for basic interventions, based on the available evidence and expert opinion...
November 19, 2018: Intensive Care Medicine
Olfa Hamzaoui, Jean-Louis Teboul
The article has been temporarily removed as a rebuttal in this PRO-CON debate has yet to be added. The full Elsevier Policy on Article Withdrawal can be found at
November 14, 2018: Journal of Critical Care
Mathieu Jozwiak, Xavier Monnet, Jean-Louis Teboul
Fluid administration is the first-line therapy in patients with acute circulatory failure. The main goal of fluid administration is to increase the cardiac output and ultimately the oxygen delivery. Nevertheless, the decision to administer fluids or not should be carefully considered, since half of critically ill patients are fluid unresponsive, and the deleterious effects of fluid overload clearly documented. Thus, except at the initial phase of hypovolemic or septic shock, where hypovolemia is constant and most of the patients responsive to the initial fluid resuscitation, it is of importance to test fluid responsiveness before administering fluids in critically ill patients...
September 2018: Annals of Translational Medicine
David J Lederer, Scott C Bell, Richard D Branson, James D Chalmers, Rachel Marshall, David M Maslove, David E Ost, Naresh M Punjabi, Michael Schatz, Alan R Smyth, Paul W Stewart, Samy Suissa, Alex A Adjei, Cezmi A Akdis, Elie Azoulay, Jan Bakker, Zuhair K Ballas, Philip G Bardin, Esther Barreiro, Rinaldo Bellomo, Jonathan A Bernstein, Vito Brusasco, Timothy G Buchman, Sudhansu Chokroverty, Nancy A Collop, James D Crapo, Dominic A Fitzgerald, Lauren Hale, Nicholas Hart, Felix J Herth, Theodore J Iwashyna, Gisli Jenkins, Martin Kolb, Guy B Marks, Peter Mazzone, J Randall Moorman, Thomas M Murphy, Terry L Noah, Paul Reynolds, Dieter Riemann, Richard E Russell, Aziz Sheikh, Giovanni Sotgiu, Erik R Swenson, Rhonda Szczesniak, Ronald Szymusiak, Jean-Louis Teboul, Jean-Louis Vincent
No abstract text is available yet for this article.
September 19, 2018: Annals of the American Thoracic Society
Jean-Louis Teboul, Xavier Monnet, Denis Chemla, Frédéric Michard
Fluid administration leads to a significant increase in cardiac output in only half of ICU patients. This has led to the concept of assessing fluid responsiveness before infusing fluid. Pulse pressure variation (PPV), which quantifies the changes in arterial pulse pressure during mechanical ventilation, is one of the dynamic variables that can predict fluid responsiveness. The underlying hypothesis is that large respiratory changes in left ventricular stroke volume, and thus pulse pressure, occur in cases of biventricular preload responsiveness...
January 1, 2019: American Journal of Respiratory and Critical Care Medicine
Glenn Hernández, Alexandre Biasi Cavalcanti, Gustavo Ospina-Tascón, Arnaldo Dubin, Francisco Javier Hurtado, Lucas Petri Damiani, Gilberto Friedman, Ricardo Castro, Leyla Alegría, Maurizio Cecconi, Jean-Louis Teboul, Jan Bakker
BACKGROUND: ANDROMEDA-SHOCK is an international, multicenter, randomized controlled trial comparing peripheral perfusion-targeted resuscitation to lactate-targeted resuscitation in patients with septic shock in order to test the hypothesis that resuscitation targeting peripheral perfusion will be associated with lower morbidity and mortality. OBJECTIVE: To report the statistical analysis plan for the ANDROMEDA-SHOCK trial. METHODS: We describe the trial design, primary and secondary objectives, patients, methods of randomization, interventions, outcomes, and sample size...
July 30, 2018: Revista Brasileira de Terapia Intensiva
Mathieu Jozwiak, Xavier Monnet, Jean-Louis Teboul
PURPOSE OF REVIEW: Hemodynamic investigations are required in patients with shock to identify the type of shock, to select the most appropriate treatments and to assess the patient's response to the selected therapy. We discuss how to select the most appropriate hemodynamic monitoring techniques in patients with shock as well as the future of hemodynamic monitoring. RECENT FINDINGS: Over the last decades, the hemodynamic monitoring techniques have evolved from intermittent toward continuous and real-time measurements and from invasive toward less-invasive approaches...
August 2018: Current Opinion in Critical Care
Valentina Girotto, Jean-Louis Teboul, Alexandra Beurton, Laura Galarza, Thierry Guedj, Christian Richard, Xavier Monnet
BACKGROUND: The hemodynamic effects of the passive leg raising (PLR) test must be assessed through a direct measurement of cardiac index (CI). We tested whether changes in Doppler common carotid blood flow (CBF) and common femoral artery blood flow (FBF) could detect a positive PLR test (increase in CI ≥ 10%). We also tested whether CBF and FBF changes could track simultaneous changes in CI during PLR and volume expansion. In 51 cases, we measured CI (PiCCO2), CBF and FBF before and during a PLR test (one performed for CBF and another for FBF measurements) and before and after volume expansion, which was performed if PLR was positive...
May 29, 2018: Annals of Intensive Care
Jean-Louis Teboul, Maurizio Cecconi, Thomas W L Scheeren
No abstract text is available yet for this article.
June 2018: Intensive Care Medicine
Manu L N G Malbrain, Niels Van Regenmortel, Bernd Saugel, Brecht De Tavernier, Pieter-Jan Van Gaal, Olivier Joannes-Boyau, Jean-Louis Teboul, Todd W Rice, Monty Mythen, Xavier Monnet
In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. We are faced with many open questions regarding the type, dose and timing of intravenous fluid administration. There are only four major indications for intravenous fluid administration: aside from resuscitation, intravenous fluids have many other uses including maintenance and replacement of total body water and electrolytes, as carriers for medications and for parenteral nutrition...
May 22, 2018: Annals of Intensive Care
Daniel De Backer, Jan Bakker, Maurizio Cecconi, Ludhmila Hajjar, Da Wei Liu, Suzanna Lobo, Xavier Monnet, Andrea Morelli, Sheila Neinan Myatra, Azriel Perel, Michael R Pinsky, Bernd Saugel, Jean-Louis Teboul, Antoine Vieillard-Baron, Jean-Louis Vincent
While the pulmonary artery catheter (PAC) is still interesting in specific situations, there are many alternatives. A group of experts from different backgrounds discusses their respective interests and limitations of the various techniques and related measured variables. The goal of this review is to highlight the conditions in which the alternative devices will suffice and when they will not or when these alternative techniques can provide information not available with PAC. The panel concluded that it is useful to combine different techniques instead of relying on a single one and to adapt the "package" of interventions to the condition of the patient...
June 2018: Intensive Care Medicine
Xavier Monnet, Jean-Louis Teboul
Many efforts have been made to predict, before giving fluid, whether it will increase cardiac output. Nevertheless, after fluid administration, it is also essential to assess the therapeutic efficacy and to look for possible adverse effects. Like for any drug, this step should not be missed. Basically, volume expansion is aimed at improving tissue oxygenation and organ function. To assess this final result, clinical signs are often unhelpful. The increase in urine output in case of acute kidney injury is a poor marker of the kidney perfusion improvement...
April 24, 2018: Annals of Intensive Care
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