Programme scientifique

Programme format PDF

 

jeudi 24 janvier 2019

Session Thématique
11h00 - 12h20
N02
Médecin : Nouveautés dans l'arrêt cardio-respiratoire

Session Commune SRLF - SFMU

Modérateur(s) : Eric Maury (Paris / FRANCE), Agnès Ricard-Hibon (Pontoise / FRANCE)
  • Prédire la survie dès le pré-hospitalier 
    Orateur(s) :
    • Guillaume Debaty (Grenoble / FRANCE)
    11h00 / 11h20
  • Alternative(s) à l'adrénaline ?
    Orateur(s) :
    • Florence Dumas (Paris / FRANCE)
    11h20 / 11h40
  • Quelles limites au « low-flow » ?
    Orateur(s) :
    • Alain Cariou (Paris / FRANCE)
    11h40 / 12h00
  • Nouveaux outils pronostiques
    Orateur(s) :
    • Mauro Oddo (Lausanne / SUISSE)
    12h00 / 12h20
Session Thématique
11h00 - 12h20
S01
Infirmier(e) : Ces pathologies où il faut aller vite 2

            Session Commune CCI - CMU

Modérateur(s) : Paul Buccas-Français (Paris / FRANCE), David Huard (Nevers / FRANCE)
  • Crush syndrome
    Orateur(s) :
    • Benoît Vivien (Paris / FRANCE)
    11h00 / 11h20
  • Intoxications aux médicaments cardiotropes
    Orateur(s) :
    • Sébastien Beaune (Paris / FRANCE)
    11h20 / 11h40
  • Fasciite nécrosante - gangrène de Fournier
    Orateur(s) :
    • Nicolas de Prost (Créteil / FRANCE)
    11h40 / 12h00
  • Dysthyroïdies graves
    Orateur(s) :
    • Matthieu Schmidt (Paris / FRANCE)
    12h00 / 12h20
Session Thématique
11h00 - 12h20
S02
Médecin : Infections virales

Session Commune SRLF - SPILF

Modérateur(s) : Florence Ader (Lyon / FRANCE), Laurent Papazian (Marseille / FRANCE)
  • Grippe grave : qui et comment traiter ?
    Orateur(s) :
    • Fabrice Bruneel (Versailles / FRANCE)
    11h00 / 11h20
  • Rougeole
    Orateur(s) :
    • Pierre Tattevin (Rennes / FRANCE)
    11h20 / 11h40
  • Méningo-encéphalites virales
    Orateur(s) :
    • Romain Sonneville (Paris / FRANCE)
    11h40 / 12h00
  • Virus émergents
    Orateur(s) :
    • Marc Lecuit (Paris / FRANCE)
    12h00 / 12h20
Session Thématique
11h00 - 12h20
S03
Médecin : Stratégie libérale versus restrictive
Modérateur(s) : Bruno Lévy (Nancy / FRANCE), Peter Radermacher (Ulm / ALLEMAGNE)
  • Les fluides
    Orateur(s) :
    • Frédérique Schortgen (Créteil / FRANCE)
    11h00 / 11h20
  • L'oxygène
    Orateur(s) :
    • Pierre Asfar (Angers / FRANCE)
    11h20 / 11h40
  • La transfusion
    Orateur(s) :
    • Michael Piagnerelli (Charleroi / BELGIQUE)
    11h40 / 12h00
  • Les catécholamines
    Orateur(s) :
    • Jean-Louis Teboul (Le Kremlin-Bicêtre / FRANCE)
    12h00 / 12h20
Controverse
12h30 - 13h30
E07
Kinésithérapeutes : La kinésithérapie motrice peut-elle être considérée comme une urgence ?
Modérateur(s) : Cheryl Hickmann (Bruxelles / BELGIQUE)
  • Pour
    Orateur(s) :
    • Pauline Wild (Pontoise / FRANCE)
    12h30 / 13h00
  • Contre
    Orateur(s) :
    • Clément Médrinal (Le Havre / FRANCE)
    13h00 / 13h30
Session Thématique
12h35 - 13h55
E01
Médecin : La recherche pendant l'internat
Thématique : Commission Jeunes
  • J'ai une idée, comment je monte mon étude ?
    Orateur(s) :
    • Etienne de Montmollin (Paris / FRANCE)
    12h35 / 12h55
  • Publication, Impact Factor, SIGAPS, qu'est-ce-que ça veut dire ?
    Orateur(s) :
    • Wulfran Bougouin (Paris / FRANCE)
    12h55 / 13h15
  • Je pars à l'étranger pour la recherche, comment ça se passe ?
    Orateur(s) :
    • Stéphanie Pons (Paris / FRANCE)
    13h15 / 13h35
Communications orales
13h30 - 15h00
735-736
Kinésithérapeutes : Communications libres SKR
Modérateur(s) : Ingrid Koube (Bruxelles / BELGIQUE)
  • Aerodigestive tract ultrasound imaging: principles and interests for physiotherapy
    Orateur(s) :
    • Carlos Diaz Lopez (Férolles-Attilly / FRANCE)
    • Aymeric Le Neindre (Suresnes / FRANCE)
    13h30 / 13h45
    Abstract : The clinical assessment of swallowing disorders in ICU has many limitations in its reliability and accuracy. The reference standard imaging techniques, such as fluoroscopy, still rely their analysis on the operator's subjective conclusion (see table 1) (1) (2). In this context, ultrasound imaging, that can be performed at the patient's bedside, is a non-invasive tool allowing the evaluation of the main structures involved in all the swallowing phases and may be a promising tool to dysphagia assessment (3). This is a narrative review on the interests of ultrasound imaging for swallowing assessment as well as on its perspective of use in physiotherapy. The figures and practical descriptions are the result of the authors' everyday use of ultrasound imaging.Ultrasound imaging allows a quantitative and qualitative examination of the majority of the swallowing structures, such as tongue, oropharyngeal muscles, larynx, and upper esophageal sphincter (UES). It assesses the tongue kinetics, looking for abnormal movements, and the contractility and thickness of the oropharyngeal muscles, which enables to assess a potential dysfunction (4) (5). Physiotherapists may also follow the larynx movements (in coronal and sagittal planes) evaluating the displacement of the hyoid bone (6). A decrease in the hyoid bone displacement and contraction of the tongue may explain a dysphagia (7). Finally, ultrasound imaging can measure the displacement and the opening-closing diameters of the upper esophagus sphincter (UES), allowing to detection of dysphagia related to UES disorders. Ultrasound imaging of the aerodigestive tract may improve the quantitative and qualitative examination of the swallowing structures. The use of this method requires a deep understanding of the ultrasound imaging principles and of the swallowing physiopathology in order to be able to benefit from its potential. Ultrasound imaging seems to be a promising tool for physiotherapy, used as an outcome in clinical research or during clinical practice in order to improve the diagnosis of the dysfunctions related to dysphagia.
  • Bench assessment of the effect of a collapsible tube on the efficacy of a mechanical insufflation-exsufflation device
    Orateur(s) :
    • Romain Lachal (Lyon / FRANCE)
    13h45 / 14h00
    Abstract : Mechanical Insufflation-Exsufflation (MI-E) by using a specific device is commonly used to increase weak cough, as in patients with chronic neuromuscular weakness or in intensive care unit (ICU) patients with ICU-acquired neuro-myopathy. The assessment of the efficacy of MI-E device is commonly done by measuring peak cough flow (PCF). Upper airways collapse is frequently associated with neuromuscular disease and may compromise MI-E efficacy. Tracheomalacia is another disease that may impede PCF to increase with MI-E device. The goal of present study was to carry out a bench study to assess the effect of MI-E on PCF with and without the presence of a collapsible tube. Our hypothesis was that PCF was lower with than without collapsible tube.We used a lung simulator (TTL Michigan Instruments) with adjustable compliance (C) and resistance (R) to which a MI-E (CoughAssist E70, Philips-Respironics) was attached, with or without a latex collapsible tube. Flow and pressure were proximal to the lung simulator. Six C-R combinations were tested, each with and without the collapsible tube. For each C-R combination, we set ±30, ±40 and ±50 cmH2O inspiratory/expiratory pressure at the MI-E device. MI-E device was set in automatic mode with inspiratory time of 3s, expiratory time of 3.2s and pause of 2s. Each set was recorded by using a data logger (Biopac 150, Biopac inc.) and the last 5 cycles were used for the analysis done by using Acqknowledge software (Biopac inc.). The peak expiratory flow during the first 100 ms after onset of expiration was taken as the surrogate of PCF. The corresponding pressure was also recorded.Contrary to our hypothesis, the peak expiratory flow during the first 100ms of exsufflation phase is higher with than without the collapsible tube in every C-R condition, as shown in figure 1 . For the C20R5 condition the effect of the collapsible tube on the intercept (-0.35 cmH2O) was not significant but this was offset by a significant increase in slope (+0.12 L/s/cmH2O). For the other conditions, the collapsible tube significantly increased PEF at 30 cmH2O expiratory pressure and the gap further increased above this pressure because the slope increased with the collapsible tube. We found that peak expiratory was higher with than without collapsible tube. In vivo measurements in patients should be done to confirm this finding.
  • Early verticalization in neurologic intensive care units with a weight suspension system.
    Orateur(s) :
    • Margrit Ascher (Montpellier / FRANCE)
    • Francisco Miron Duran (Montpellier / FRANCE)
    • Fanny Pradalier (Montpellier / FRANCE)
    • Claire Jourdan (Montpellier / FRANCE)
    • Kevin Chalard (Montpellier / FRANCE)
    • Flora Djanikian (Montpellier / FRANCE)
    • Isabelle Laffont (Montpellier / FRANCE)
    • Pierre-François Perrigault (Montpellier / FRANCE)
    14h00 / 14h15
    Abstract : Background. Current literature and French guidelines recommend early mobilization in Intensive Care Units (ICU), including verticalization and walking. Verticalization for neurologic patients in ICU is challenging because of neurological impairments, risks of falls and of clinical worsening. In the neuro-ICU of Montpellier university hospital, a weight suspension system (LiteGait®) is used. Objectives. To study the feasibility and safety of walking with the weight suspension system in a neuroICU. Feasibility involved proportion of patients who benefited from suspension walking, reasons for not using it, physiotherapists' time required. Safety involved rate of adverse events, changes in vital parameters, pain. Design. Monocentric, prospective, descriptive study, including all neurogical patient hospitalized for > 48 hours in ICU with initial mechanical ventilation from mid-February to mid-September 2018 (excluding deceased patients). Criteria for using suspension walking where respiratory stability without mechanical ventilation (tracheostomy and/or oxygen therapy possible), hemodynamic and neurologic stability, sufficient respond to command (head control, testing of one quadriceps > 3 or two quadriceps > 2). Data included general description of patients; clinical status before suspension walking (pain, MRC testing, sitting balance, RASS, hemodynamic and respiratory parameters, medical equipment); pain, hemodynamic and respiratory parameters during sessions; description of adverse events and consequences; duration of walking.Results. Among 83 patients included (see table for characteristics), 25% benefited from suspension walking during their stay; for 25% of patients, suspension walking was needed but hindered by organization difficulties (such as timetable challenges, early discharge from ICU); 22% patients could walk without suspension on first verticalization; 20% were too impaired to use suspension walking. A total of 41 suspension walking sessions were performed. Five sessions needed to be interrupted for the five following reasons: pain, hypotension, dizziness, diarrhea and dysfunction of the device. No adverse event had clinical consequences beyond the session. Pain score raised significantly for one patient only (5 points in BPS score). Mean delay between extubation (or tracheotomy) and first suspension walking was 7 days. Mean delay between first suspension walking and first walking without suspension was 8 days. Conclusion. Verticalization with a suspension device in a neurologic ICU is feasible and safe, with a trained and supported team. Obstacles such as medical equipment, language impairments, absence of balance, heavy weight, poor tonicity and participation can be overcome using such a device. Suspension could enable several neurologic ICU patients to walk one week earlier.
  • Effects of active exercise on red blood cell deformability in critically ill patients
    Orateur(s) :
    • Vinciane Scaillet (Charleroi / BELGIQUE)
    • Mohera Potvin (Charleroi / BELGIQUE)
    • Damien Wathelet (Charleroi / BELGIQUE)
    • Adrien Fievet (Charleroi / BELGIQUE)
    • Ingrid Leclercq (Charleroi / BELGIQUE)
    • Karim Zouaoui Boudjeltia (Charleroi / BELGIQUE)
    • Patrick Biston (Charleroi / BELGIQUE)
    • Michael Piagnerelli (Charleroi / BELGIQUE)
    14h15 / 14h30
    Abstract : Early mobilization is recommended in critically ill patients to limit the rapid decrease in muscle mass and function. Several methods, in addition of mobilization are used including passive/active in-bed cycling and muscle electrostimulation (ESM). This latter could improve the muscle microcirculation assessed by tissue oxygen saturation and red blood cell (RBC) deformability in untrained athletes by a RBC-nitric oxide production mechanism. In a monocentric, randomized trial, we investigated in critically ill patients, the effects of a passive/active exercise alone or associated with a daily ESM or with a daily in-bed cycling sessions on RBC deformability.Patients were randomized during the first 48 h of ICU admission in three groups: passive and/or active mobilization (M) twice a day or M once a day associated with a daily session of 30-min legs passive/active in-bed cycling (CYCLE) or M once a day associated with a daily session of 30-min legs ESM (ESM). Demographic data, PaO2/FiO2 and lactate levels were recorded before and after the session. RBC deformability was assessed ex-vivo, before and after exercise, by the Laser-assisted Optical Rotational Cell Analyzer (LORCA, Mechatronics Instruments BV, AN Zwaag, Netherlands) with the elongation index (EI) in relation to the shear stress (0.3 to 50 Pa) applied on the RBC membrane. Data were expressed by the median value 25-75% range of delta EI (EI after minus EI before exercise) and compared by Kruskal-Wallis one way test. A p value < 0.05 was considered as statistically significant.10 patients in each group were included. PaO2/FiO2 (before: 318 (280-381) versus 310 (246-376) after; p = 0.46) and lactate levels (1.3(0.8-2.0) versus 1.4(1.0-2.0) mmol/L; p = 0.65) were not modified whatever the type of exercise. Only, in the ESM group, delta EI was significantly decreased for several low shear stress (0.76, 1.21 and 1.93 Pa) compared to the two other groups. Association of active/passive mobilization and ESM alter at least for low shear stress, the RBC deformability in critically ill patients. Effects on long term treatment by this technique on RBC rheology and on muscle metabolism need to be investigated.
  • Neurogenic para-osteoarthropathy in severe brain injury in the emergency department of CHUOran Emergencies (Algeria)
    Orateur(s) :
    • Youcef Oubadi (Oran / ALGÉRIE)
    • Soumia Benbernou (Oran / ALGÉRIE)
    • Khalida Bouyacoub (Oran / ALGÉRIE)
    • Nabil Ghomari (Oran / ALGÉRIE)
    • Abdelkader Azza (Oran / ALGÉRIE)
    • Houria Pr Djebli France (Oran / ALGÉRIE)
    14h30 / 14h45
    Abstract : Neurogenic para-osteoarthropathy (NOSP) is a common complication after severe head trauma, and NANP can be complicated by joint damage ranging from amplitude limitation to ankylosis. This complication is frequently encountered in the service. Objectives: Determine the frequency of NOPOs in the Emergency Resuscitation Department Establish a prevention protocol established by the physiotherapists of the service. The exposed work was carried out at the URC resuscitation unit of CHUOran. This is a prospective study spread over two years (2015 and 2017) involving 76 patients. The study population consists of severe head injuries (GCT) with a Glasgow score of 8 or less. We studied the time of onset, the affected joint, the degree of limitation; risk factorsOf the 76 TCG patients, 29 patients presented with NOPO. The onset time was an average of 14 days with extremes ranging from 10 to 20 days. The elbow was the most affected joint with knee involvement in some cases. In this series the risk factors favoring the onset of NOPO were: severity of neurological lesions, periarticular lymphoedema, arterial compression of blood pressure cuffs, duration of sedation, type of drug used - The NOPO is a complication occurring at the TCG, it causes functional sequelae that will jeopardize its socio-professional reintegration that only prevention will prevent.
  • Standing the ARDS patient
    Orateur(s) :
    • Guillaume Fossat (Orléans / FRANCE)
    • Emmanuelle Desmalles (Orléans 2 / FRANCE)
    14h45 / 15h00
    Abstract : Standing the ICU patient became a routine care in early mobility programs. In the awake patient, stand can improve minute ventilation, paO2 and awareness. Undesirable effect can be a decreased in Arterial Pressure. To perform stand position in the ICU patient the physiotherapist needs to move him out of the ICU bed. Recently, standing position can be performed directly in the bed. In ARDS patient, positioning is one of the major component of the care. Upright and prone positioning showed many benefits. Prone decreased the mortality rate up to 50% in ARDS patients. Upright position improves the oxygenation effects in ARDS patients. Instead, prone had several adverse effects such as pressure ulcer, endotracheal tube obstruction, and ventilator acquired pneumonia.In order to decrease the adverse effect of prone positioning we proposed to evaluate whether standing position is safe and can produced the same oxygenation effects as the prone positioning. The standing is performed directly in a dedicated ICU bed, in severe and moderate ADRS patients according to the BERLIN definition. To prevent hypotension, we use an anti shock pants that can be inflate up to 40 mmHg. Standing is performed on a multiple step angulation program, based on the clinical patient responses during 15 minutes each step: 25° => 40° => 55° => 40° => 25° Arterial blood sample is performed before and at the completion of the technique. Static compliance is calculated at each angulation step.For now we only performed one Stand in ARDS patient. No adverse event occurred during the technique. The SpO2, the Blood Pressure remain stable and the anti-shock pants was no inflate. The heart rate rise up from 112 BPM to 132 BPM. The static compliance was stable between the begin and the end ( 25,00 and 26,92). The P/F ratio increase from 171 to 211 at the end of the manoeuver.Upright position was already evaluated in some studies, it shows benefits only in "responders" patient during ARDS. Whereas upright is not standing, because the real incline angle during upright is 26°. With this technique, the patient can be stand for real on his feet, in a posture that is similar as the human stand position.This technique appears to be safe and can produce positive effects on the P/F ratio without change in static compliance during ARDS Volume Controlled Ventilation. Further patients need to test this technique to prove real effects.
Atelier
14h10 - 15h10
E01
Infirmier(e) : Gestion des conflits en réanimation
Modérateur(s) : Virginie Souppart (Paris / FRANCE)
  • Gestion des conflits en réanimation
    Orateur(s) :
    • Elie Azoulay (Paris / FRANCE)
    14h10 / 15h10
Communications orales
14h10 - 15h10
E02
Médecin : Optimisation de l'antibiothérapie
Modérateur(s) : Jean-François Timsit (Paris / FRANCE), Pierre Tattevin (Rennes / FRANCE)
  • Effect of empirical aminoglycoside combination therapy on mortality in patients with septic shock: a propensity-based analysis
    Orateur(s) :
    • Jean-Francois Llitjos (Paris / FRANCE)
    • Simon Meslin (Paris / FRANCE)
    • Julien Charpentier (Paris / FRANCE)
    • Alain Cariou (Paris / FRANCE)
    • Jean-Paul Mira (Paris / FRANCE)
    • Matthieu Jamme (Paris / FRANCE)
    • Frédéric Pène (Paris / FRANCE)
    14h10 / 14h25
    Abstract : Current guidelines recommend combination antibiotic therapy for patients with septic shock. However the supporting evidence is scarce. The aim of this study is to address the impact of aminoglycoside combination therapy on mortality in septic shock.This was a 9-year (2008-2016) monocenter retrospective study. All adult patients diagnosed with septic shock within the first 48 hours were included. Septic shock was defined as a microbiologically proven or clinically suspected infection, associated with acute circulatory failure requiring vasopressors. Empirical combination therapy was defined by the addition of aminoglycosides within 36 hours from the diagnosis of septic shock. A propensity score for aminoglycoside administration was built using day 1 demographic and clinical characteristics. The determinants of mortality were assessed using a propensity-adjusted Cox proportional hazards competing risk analysis. During the study period, 1040 patients were admitted for septic shock. Among them, 64% were males, the median age was 69 [57; 78] years old. The crude in-ICU mortality rate was 35%. The antibiotic regimen was based on beta lactam therapy in almost all patients (99%), combined with aminoglycosides in 616 (59%) patients. First-line aminoglycosides were distributed into amikacin (61%), gentamicin (37%) and tobramycin (2%). Patients receiving aminoglycoside combination therapy were more frequently immunocompromised (40.4% vs. 31.84%, p=0.005), had more positive blood cultures (39.1 % vs. 25 %, p<0.0001) and had a higher creatininemia at admission (144 [95;228] vs. 131 [80;201] μmol/L, p=0.007). After propensity score-based matching, 348 patients receiving aminoglycoside combination therapy were compared to 348 patients treated without aminoglycosides. Demographics and clinical characteristics on admission were similar in the two matched groups. The mortality rates in patients treated or not with aminoglycoside combination therapy were 36,2% and 30% (p=0.07 in univariate analysis), respectively. In propensity-adjusted Cox proportional hazards multivariate competing risk analysis, aminoglycoside combination therapy was not associated with mortality (CSH=1.19, 95%CI=0.90-1.55, p=0.25). After matching, day 3 creatininemia was similar in both groups (91 [54;158] vs. 89.5 [54.75;158] μmol/L, p=0.86) whereas creatininemia at discharge was higher in patients treated with aminoglycoside combination therapy (92.5 [58 - 177] vs. 79.5 [54 - 137.5] μmol/L, p=0.02). In septic shock patients, antibiotic combination with aminoglycosides was associated with neither benefit nor harm.
  • Potential impact of real-time processing and rapid susceptibility testing of blood samples in severe gram-negative bloodstream infections
    Orateur(s) :
    • Sophie Alviset (Paris / FRANCE)
    • Julien Charpentier (Paris / FRANCE)
    • Poupet Hélène (Paris / FRANCE)
    • Poyart Claire (Paris / FRANCE)
    • Jean-Paul Mira (Paris / FRANCE)
    • Kerneis Solen (Paris / FRANCE)
    14h25 / 14h40
    Abstract : Timely appropriate therapy is critical in patients with gram-negative bloodstream infections. In standard care, blood cultures are processed during operating hours of the laboratory (8:30-18:30 in our setting). We evaluated the potential impact of real-time processing (24 hours a day) and rapid antimicrobial susceptibility testing (AST) on antibiotic regimen in intensive care unit (ICU) patients. We retrospectively reviewed all episodes of gram-negative bloodstream infections occurring in the ICU of our 1500-bed hospital between 1st January and 31s December 2017. We collected data on demographics, outcomes, timeframes of sample processing/testing and antibiotic changes. Secondly, three scenarios were simulated on the dataset: (1) Real-time processing + conventional techniques (gram stain and standard AST); (2) Standard processing (8:30-18:30) + rapid AST; (3) Real-time processing + rapid AST In scenarios 1 and 3, transportation time of blood samples to the laboratory was set at 2 hours. In scenarios 2 and 3, time to AST result was set at 7 hours. We included 86 episodes in 76 patients: 52 men (68%), median age 67 [interquartile range: 53-78]). Median Charlson's score was 5 [0-15], and 28 patients (37%) died in the ICU. Infection episodes were mainly digestive (26; 30%) or catheter related (16; 19%). Most frequent pathogens were: E. coli (36, 33%), Enterobacter sp (20, 18%), P. aeruginosa (11, 10%). Reception of the AST led to a change of the antibiotic regimen in 53/86 (62%) episodes (de-escalation in 46). In standard care, median timeframe from blood collection to gram stain was 26 hours [19-34] and from gram stain to AST 29 hours [27-50]. Median timeframe for complete processing of blood samples (from collection to result of definitive AST) was 61 hours [53-77] in standard care, 48 hours [42-66] in scenario 1, 33 hours [26-41] in scenario 2 and 22 hours [20-27] in scenario 3. Over the whole sample, scenario 1, 2 and 3 had the potential to prompt antibiotic change to pathogen-directed therapy by an average of 5.6, 18.6 and 24.1 hours respectively.Real-time processing and rapid AST of blood cultures have a high potential to decrease time to antibiotic change in severe gram-negative bloodstream infections. This effect must be balanced with cost of diagnostic kits and around-the-clock staffing expenses.
  • Prevalence of insufficient plasma concentration of beta-lactam antibiotics ICU patients: a one-year retrospective single centre study.
    Orateur(s) :
    • Sacha Sarfati (Rouen / FRANCE)
    • Fabien Lamoureux (Rouen / FRANCE)
    • Elsa Desmarest-Durand (Rouen / FRANCE)
    • Soumaya Skallil (Rouen / FRANCE)
    • Thomas Clavier (Rouen / FRANCE)
    • Dorothée Carpentier (Rouen / FRANCE)
    • Steven Grange (Rouen / FRANCE)
    • Gaetan Beduneau (Rouen / FRANCE)
    • Fabienne Tamion (Rouen / FRANCE)
    • Christophe Girault (Rouen / FRANCE)
    • Benoit Misset (Rouen / FRANCE)
    14h40 / 14h55
    Abstract : Beta-lactam antibiotics effectiveness is time-dependent and requires that their plasmatic concentration is constantly over the Minimal Inhibiting Concentration (MIC) of the targeted bacterial strain. Dosing recommended by the pharmaceutical companies is based on data derived from patients with non severe diseases and may not be appropriate for ICU patients with sepsis, due to variable alteration of elimination or volume distribution. Our objective was to assess the prevalence of insufficient plasma concentrations of beta-lactam antibiotics in ICU septic patients treated with usual dosing and frequency. Retrospective analysis of therapeutic drug monitoring (mass spectrometry) between December 2016 and November 2017 for 6 molecules. We selected those assessments performed between 4 and 8 hours after IV administration for amoxicillin (AMX); 3 and 6 hours for cloxacillin (CLO), 6 and 12 hours for piperacillin (PIP), 6 and 12 hours for meropinem (MEM), 8 and 24 hours for cefepime (FEP), and 12 and 24 hours for ceftriaxone (CRO). EUCAST inferior breakpoint was used for each molecule to approach usual MICs.178 samples were assessed, of which 127 were residual concentrations (AMX = 24, CLO = 7, PIP = 62, MEM = 14, FEP =, 7, CRO = 13) in 88 patients. Age = 61 +- 14, SAPS 2 = 50 +- 19, weight = 75 +- 22 kg, body mass index = 28 +- 6, shock = 56 %, renal replacement therapy = 17%, LOS in ICU = 15.2 +- 12.8 d, mortality = 25 %. 30/127 plasma concentrations (23.6%) were below the EUCAST inferior breakpoint: AMX = 4 (17 %), CLO = 1 (14 %), PIP = 15 (24.1%), MEM 8 (57.1%), FEP = 1 (14.3%), and CRO = 1 (5.8%). Except for MEM and CRO, plasma concentrations were poorly correlated with the time from infusion to sample. Patients with insufficient concentrations were younger (52 +- 15 versus 64 +- 13, p 0.006) and had longer ICU stays before dosage (14 +- 9 vs 7 +- 6 days, p = 0.0001). They had similar ICU length of stay after dosage (11 +- 13 vs 7 +- 8 days, p = 0.16), sex ratio, SAPS 2 scores, weight, BMI, shock, RRT use, and mortality. In our ICU population, usual dosing and frequency of beta-lactam antibiotics led to insufficient plasma level concentrations in 24 % of cases, particularly for antibiotics with short half-lives and in younger patients. Insufficient concentrations were more frequently observed during late ICU antibiotic treatments.
  • Impact of the Unyvero HPN test in ICU patients with ventilator-associated pneumonia or severe hospital-acquired pneumonia
    Orateur(s) :
    • Nathan Peiffer-Smadja (Paris / FRANCE)
    • Lila Bouadma (Paris / FRANCE)
    • Kahina Allouche (Paris / FRANCE)
    • Martin Reboul (Paris / FRANCE)
    • Philippe Montravers (Paris / FRANCE)
    • Jean-François Timsit (Paris / FRANCE)
    • Laurence Armand Lefevre (Paris / FRANCE)
    14h55 / 15h10
    Abstract : Early appropriate antibiotic therapy reduces morbidity and mortality of severe hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). However, the emergence of bacterial resistance requires the early use of antibiotics with the narrowest possible spectrum.The Unyvero Hospitalized Pneumonia (HPN, Curetis) test is a multiplex PCR detecting 21 bacteria and 19 resistance genes on respiratory samples within 5 hours. We assessed the performance and impact of the Unyvero HPN test in ICU patients. In this prospective single-center study, conducted in 3 ICUs, we performed a Unyvero HPN test on bronchoalveolar lavage (BAL) or plugged telescoping catheters (PTC) samples of patients suspected of VAP or HAP with Gram-negative bacilli or clustered Gram-positive cocci on Gram staining. We evaluated the performance (sensitivity and specificity) of the test compared to conventional culture methods and its potential impact on the choice of antibiotic therapy.We analyzed 71 samples (54 BAL and 10 PTC) from 63 patients (52 males, median age 64 years). A total of 69/84 bacteria were detected by the Unyvero test with a sensitivity of 82% (95% CI, 72-90%) and a specificity of 99% (95% CI 98-100). The performance of the test is shown in the table below. For Pseudomonas aeruginosa, the most frequently isolated pathogen (n = 22), sensitivity and specificity were 100% and 98%, respectively. Two cases of relapses of pneumonia were observed with bacteria detected by the Unyvero test but not initially found with the conventional culture. The 4 extended-spectrum beta-lactamases (ESBL) and 2 carbapenemases (NDM) were all detected by the Unyvero test. The clinical evaluation of 33 episodes of pneumonia showed that the Unyvero test would have led to 22 (67%) therapeutic changes. Of these, 3 corresponded to antibiotic therapy initiations and 19 to modifications in antibiotic treatment including 11 (33%) de-escalations, 5 (15%) adequations or improvement of antibiotic therapy and 3 (10%) less adapted therapies. The Unyvero HPN test has good performance. Its use could lead to changes in antibiotic therapy that are mainly favorable for patients and limit the selection pressure by reducing the antibiotic spectrum early.
Communications orales
14h10 - 15h10
E03
Médecin : Médecine d'urgence
Modérateur(s) : Patrick Ray (Dijon / FRANCE), Agnès Ricard-Hibon (Pontoise / FRANCE)
  • Medical rhabdomyolysis in critically ill patients: initial presentation and short- and long-term outcomes
    Orateur(s) :
    • Ines Gragueb-Chatti (Lyon / FRANCE)
    • Romain Hernu (Lyon / FRANCE)
    • Marie Simon (Lyon / FRANCE)
    • Thomas Baudry (Lyon / FRANCE)
    • Thomas Madelaine (Lyon / FRANCE)
    • Adeline Grateau (Lyon / FRANCE)
    • Martin Cour (Lyon / FRANCE)
    • Laurent Argaud (Lyon / FRANCE)
    14h10 / 14h25
    Abstract : Rhabdomyolysis is a common pathology in intensive care unit (ICU), often associated with acute kidney injury (AKI) and high mortality rate. To date, clinical course and prognostic factors of medical rhabdomyolysis in ICU are poorly documented. The aim of the study was to describe characteristics and evolution of critically-ill patients with medical rhabdomyolysis and to identify prognostic factors associated with short and long-term outcomes.A retrospective study was conducted between January 2006 and December 2016, in the three medical ICUs of Lyon (France). All adult patients hospitalized with severe medical rhabdomyolysis (creatine kinase [CK] > 5,000 IU/L) were included. Demographic features, comorbidities (Charlson score), clinical and laboratory data including AKI (according to KDIGO classification), organ failure/support, day-28 outcome and one-year mortality were collected.A total of 427 patients were included. The mean age was 55±17 years, and sex ratio was 1.8. The most common causes of rhabdomyolysis were immobilization (n=159, 37%) and sepsis (n=116, 27%). At admission, SOFA score was 8.8±5.1, and mean CK level reached 16,814±28,616 IU/L. During ICU stay, 324 patients (76%) developed AKI and 132 (31%) required renal replacement therapy. ICU, day-28, and one-year mortality were 27%, 26% and 32%, respectively. Initial CK level did not significantly differ between patients alive (18,186±30,238 IU/L) and dead (12,644±22,617 IU/L) at day 28 (p=0.05). After multivariate analysis, Charlson score and organ failures (cardiovascular, respiratory or neurological) were found to be independently associated with day-28 mortality (p<0.05). Age, Charlson score and highest SOFA score during ICU stay were independent factors associated with one-year mortality (p<0.05).These results emphasize the poor outcome of critically-ill patients with severe medical rhabdomyolysis. In this population, comorbidities and organ failures, but not initial CK level, appear to be major determinants of short and long-term prognosis.
  • Are ambulance resources associated with outcome in out-of-hospital cardiac arrests? Insights from the Paris- Sudden Death Expertise Centre registry
    Orateur(s) :
    • Florence Dumas (Paris / FRANCE)
    • Richard Chocron (Paris / FRANCE)
    • Thomas Loeb (Paris / FRANCE)
    • Lionel Lamhaut (Paris / FRANCE)
    • Daniel Jost (Paris / FRANCE)
    • Frédéric Adnet (Paris / FRANCE)
    • Eric Lecarpentier (Paris / FRANCE)
    • Wulfran Bougouin (Paris / FRANCE)
    • Frankie Beganton (Paris / FRANCE)
    • Philippe Juvin (Paris / FRANCE)
    • Eloi Marijon (Paris / FRANCE)
    • Xavier Jouven (Paris / FRANCE)
    • Alain Cariou (Paris / FRANCE)
    14h25 / 14h40
    Abstract : In out-of-hospital cardiac arrest (OHCA), geographic disparities in outcomes may reflect baseline variations in patients' characteristics but may also result from differences in the number of ambulances providing basic life support (BLS) and advanced life support (ALS). We aimed at assessing the influence of allocated ambulance resources on outcome in OHCA patients in a large urban community. From May 2011 to January 2016, we analyzed a prospectively collected Utstein database for all OHCA adults. Cases were geocoded according to 19 neighborhoods and the number of BLS (firefighters performing cardiopulmonary resuscitation and applying automated external defibrillator) and ALS ambulances (medicalized team providing advanced care such as drugs and endotracheal intubation) was collected. We assessed the respective influence of Utstein parameters, socio-economic characteristics and ambulance resources of these neighborhoods using a mixed-effect model with successful return of spontaneous circulation (ROSC) as the primary endpoint and survival at hospital discharge as a secondary endpoint.During the study period, 8754 non-traumatic OHCA occurred in the Greater Paris area. Overall ROSC rate was 3675/8754 (41.9%) and survival rate at hospital discharge was 788/8754 (9%), ranging from 33% to 51.1% and from 4.4% to 14.5 % respectively, according to neighborhoods (p<0.001). Patients' and socio-demographics' characteristics significantly differed between neighborhoods (p for trend< 0.001). After adjustment, a higher density of ambulances was associated with successful ROSC (respectively aOR=1.31 (1.14-1.51); p<0.001 for ALS ambulances >1.5 per neighborhood and aOR=1.21 (1.04-1.41); p=0.01 for BLS ambulances >4 per neighborhood). Regarding survival at discharge, only the number of ALS ambulances >1.5 per neighborhood was significant (aOR= 1.30 (1.06-1.59) p=0.01).In this large urban population-based study of out-of-hospital cardiac arrests patients, we observed that allocated resources of Emergency Medical Service (EMS) are associated with outcome, suggesting that improving healthcare organization may attenuate disparities in prognosis.
  • Assessment of severe eosinopenia for the diagnosis of infection in the Emergency Department and comparison with other biomarkers
    Orateur(s) :
    • Jérémy Rosman (Charleville-Mézières / FRANCE)
    • Simon Hainguerlot (Charleville-Mézières / FRANCE)
    • Aurélien Cordonnier (Charleville-Mézières / FRANCE)
    • Karelle Staffe (Charleville-Mézières / FRANCE)
    • Olivier Gallon (Charleville-Mézières / FRANCE)
    • Thomas Beuvelet (Charleville-Mézières / FRANCE)
    • Xavier Fontaine (Charleville-Mézières / FRANCE)
    • Philippe Mateu (Charleville-Mézières / FRANCE)
    14h40 / 14h55
    Abstract : Infectious diseases represent a frequent cause of consultation in the Emergency Department (ED). Biomarkers may help clinicians to diagnose infection from other causes. Severe eosinopenia may reflect level of systemic inflammation. The aim of our study was to evaluate severe eosinopenia, as defined a value <0.01 G/L (<10/mm3), as a marker of infection. Patients admitted in the ED with at least one complete blood count were included. Biomarkers of infection were evaluated by multivariable logistic regression.Among 15.638 patients screened, 11.520 patients were finally included, 14% were infected. Severe eosinopenia was present in 49% of infected patients and 23% in non-infected patients (p <0.001). Severe eosinopenia had a modest accuracy for diagnosis of infection with 49% sensitivity, 77% specificity, 26% positive predictive value, 90% negative predictive value, 2.1 positive likelihood ratio and 0.47 négative likelihood ratio. Accuracy was lower than other biomarkers as C-reactive protein, fibrinogen, procalcitonin and (neutrophilic) leukocytosis. In mutivariable analysis, severe eosinopenia was an independant factor of infection [adjusted odds ratio 1.3, (95% confidence interval 1.1 - 1.5), but lower than other biomarkers).Severe eosinopenia, a reflect of systemic inflammation, was an independent factor associated with infection, but is not better than other usual biomarkers.
  • QSOFA as predictor of mortality and prolonged ICU admission in Emergency Department patients with suspected infection
    Orateur(s) :
    • Emmanuel Canet (Paris / FRANCE)
    • David Mcd Taylor (Melbourne / AUSTRALIE)
    • Richard Khor (Melbourne / AUSTRALIE)
    • Vivek Krishnan (Melbourne / AUSTRALIE)
    • Rinaldo Bellomo (Heidelberg / AUSTRALIE)
    14h55 / 15h10
    Abstract : We assessed the quick Sequential Organ Failure Assessment (qSOFA) score as a predictor of in-hospital mortality or prolonged ICU stay in Emergency Department (ED) patients with suspected infection. We measured qSOFA in a cohort of 11,205 ED patients with suspected infection. The primary outcome was in-hospital mortality and/or ICU stay ≥ 3 days. The qSOFA score was positive in 2,429 (21.7%) patients. In-hospital mortality, and in-hospital mortality or ICU stay ≥ 3 days were 12.8% and 17.2% respectively for qSOFA positive patients vs 2.2% and 4.2% for qSOFA negative patients (p<0.0001). For the prediction of in-hospital mortality, a positive qSOFA had a positive predictive value (PPV) of 13% (95% CI, 11-14) and a negative predictive value (NPV) of 98% (95% CI, 97-98). For the prediction of in-hospital mortality or ICU stay ≥ 3 days, the PPV and NPV of a positive qSOFA were 17% (95% CI, 16-19) and 96 (95% CI, 95-96), respectively.Among ED patients with suspected infection, a positive qSOFA identified those at much greater risk of mortality and longer ICU stay.
Session Thématique
14h10 - 15h10
E04
Infirmier(e) : Traquons l'infection
Modérateur(s) : Amandine Pucci (Créteil / FRANCE), Elise Morawiec (Paris / FRANCE)
  • Bonnes pratiques de prélèvement microbiologie
    Orateur(s) :
    • Yolaine Martin (Colombes / FRANCE)
    14h10 / 14h30
  • Nouveaux outils diagnostiques
    Orateur(s) :
    • François Barbier (Orléans / FRANCE)
    14h30 / 14h50
  • Pathogènes émergents contagieux
    Orateur(s) :
    • Gisèle Bendjelloul (Paris / FRANCE)
    14h50 / 15h10
Session Thématique
14h10 - 15h10
E05
Infirmier(e) : Assistance circulatoire
Modérateur(s) : Paulo Ferreira (Paris / FRANCE), Jérôme Rambaud (Paris / FRANCE)
  • ECMO VA : généralités & indications
    Orateur(s) :
    • Bruno Lévy (Nancy / FRANCE)
    14h10 / 14h30
  • Autres techniques d'assistance circulatoire
    14h30 / 14h50
  • ECMO VA : Gestion pratique & Principales complications 
    Orateur(s) :
    • Chirine Mossadegh (Paris / FRANCE)
    14h50 / 15h10
Communications orales
14h10 - 15h10
E06
Médecin : Insuffisance respiratoire aiguë
Modérateur(s) : Nicolas Terzi (Grenoble / FRANCE), Alexandre Demoule (Paris / FRANCE)
  • Prevalence, management and prognosis of hypoxemia among obese patients in the ICU: insights from the SPECTRUM study
    Orateur(s) :
    • Florence Boissier (Poitiers / FRANCE)
    • David Grimaldi (Bruxelles / BELGIQUE)
    • Philippe Michel (Pontoise / FRANCE)
    • Jean-Baptiste Lascarrou (Nantes / FRANCE)
    • Tai Pham (Toronto / CANADA)
    • Jean-Christophe Richard (Lyon / FRANCE)
    • Arnaud Thille (Poitiers / FRANCE)
    • Stephan Ehrmann (Tours / FRANCE)
    • Jean-Claude Lacherade (La Roche-Sur-Yon / FRANCE)
    • Grégoire Muller (Orleans / FRANCE)
    14h10 / 14h25
    Abstract : Using the SPECTRUM study, we aimed to evaluate whether hypoxemia in ICU among obese patients had different causes and management compared to non-obese patients.Subgroup analysis of a prevalence-point-day conducted in 117 French-speaking ICU aiming to report the patterns and outcomes of hypoxemic patients (defined by P/F<300mmHg). Obesity was defined as a body mass index (BMI)>30kg/m2.Among 1571 patients hospitalized in ICUs the day of the study with BMI data, 428 were obese (27 %). 247 of them were hypoxemic (57.7%) as compared with 597/1143 (52.2%) non-obese patients (p 0.05). They exhibited more frequent obesity-hypoventilation syndrome (23% versus 1.5% p < 0.001) and sleep apnea (19.4% versus 3.5% p <0.001), less frequent non-obstructive chronic respiratory disease (2% versus 8.6% p < 0.001) and interstitial pulmonary disease (1.2% versus 4.4% p 0.02 ) and had more frequently home non-invasive ventilation(NIV) (5.7 versus 2.9% p 0.05). Hypoxemia was mild in 52%, moderate in 39% and severe in 9%, similar to non-obese patients. ARDS criteria were fulfilled in 21.5% (versus 20.6% in non-obese patients). They required high flow oxygen, NIV and invasive ventilation respectively in 5.7%, 6.9% and 58.7% of cases, which was not different from non-obese patients. PEEP was higher (7 (IQR 5-10) versus 6 (IQR 5-8) cmH2O, p 0.03). Tidal volume in intubated patients was 7 ml/kg (IQR 6-8.4) in obese patients versus 6.8 (6.1-7.7) (p 0.06). Plateau pressure was not different between the 2 groups (24 versus 22 cm H2O), as well as PaO2, PaCO2 and pH. Diagnosis of atelectasis was frequent in the 2 groups (23% versus 25.7%). There was no difference in the use of prone position (5.2 versus 4.3%, p 0.66). ICU mortality of obese patients was 20.6% versus 27.4% (p 0.04). Multivariate Cox model confirmed a negative independent association between obesity and ICU mortality. Obese patients represent more than 25% of the patients hospitalized in ICU the day of the study. Hypoxemia seems more frequent in obese patients. Respiratory support and hypoxemia severity were similar between obese and non-obese patients. PEEP was higher in obese patients. Obesity was associated with a lower mortality.
  • Do all immunocompromised patients with ARF respond equally to oxygenation strategy?
    Orateur(s) :
    • Virginie Lemiale (Paris / FRANCE)
    • Audrey de Jong (Montpellier / FRANCE)
    • Guillaume Dumas (Paris / FRANCE)
    • Jordi Rello (Barcelone / ESPAGNE)
    • Michael Darmon (Paris / FRANCE)
    • Philippe Bauer (Rochester / ETATS-UNIS)
    • Andry Van de Louw (Hershey / ETATS-UNIS)
    • Julien Mayaux (Paris / FRANCE)
    • Ignacio Martin-Loeches (Dublin / IRLANDE)
    • Djamel Mokart (Marseille / FRANCE)
    • Peter Schellongowski (Vienne / AUTRICHE)
    • Sangeeta Mehta (Toronto / CANADA)
    • Achille Kouachet (Angers / FRANCE)
    • Frédéric Pène (Paris / FRANCE)
    • Peter Pickkers (Nijmegen / PAYS-BAS)
    • Gaston Burghi (Montevideo / URUGUAY)
    • Massimo Antonelli (Rome / ITALIE)
    • Fabrice Bruneel (Versailles / FRANCE)
    • Andreas Barrat Due (Oslo / NORVÈGE)
    • Miia Valkonen (Helsinki / FINLANDE)
    • Victoria Metaxa (Londres / ROYAUME UNI)
    • Anders Perner (Copenaghe / DANEMARK)
    • Julien Dessajan (Paris / FRANCE)
    • Marcio Soares (Rio de Janeiro / BRÉSIL)
    • Dominique Benoit (Ghent / BELGIQUE)
    • Martine Nyunga (Roubaix / FRANCE)
    14h25 / 14h40
    Abstract : In immunocompromised patient with acute respiratory failure (ARF), mortality remains high. First oxygenation strategy with non-invasive ventilation or high flow nasal oxygen has not been clearly demonstrated according to the patient status. We assessed assess outcomes in patients with hematological malignancies and acute respiratory failure (ARF) according to the initial ventilation strategy, radiological lesion and ARF etiology.All patients with ARF included in MINIMAX, TRIALOH and IVNICTUS studies and who were not intubated at admission, were included in this post-hoc analysis of three multicenter studies. An external validation was then performed in the EFRAIM cohort.847 patients admitted with ARF were included. At ICU admission, radiological pattern was subnormal (n=75, 9%), focal lesion (n=159; 20%), diffuse alveolar lesion (n=444; 55%) or interstitial lesion (n=127; 16%). Diagnosis of ARF was mainly related to bacterial or viral pneumonia (335, 40%). Diagnosis of ARF was not found for 147 (17%) patients. First oxygenation strategy was standard oxygen (n=310 ), NIV (n= 400), HFNO (n=65) and NIV + HFNC (n=72). Bilateral alveolar pattern (OR= 2.05 (1.00-4.22), p=0.05) was independently associated with day-28 mortality after adjusting on NIV use within the 2 first days (OR =1.76 (1.14-2.72), p=0.01), SOFA score without respiratory item at ICU admission (OR=1.16 (1.09-1.24), p<0.001) and PaO2/FiO2 <100 at ICU admission (OR= 1.69 (1.16-2.50), p=0.007). Opportunistic infection (OR= 2.16 (1.14-4.09), p=0.01) and no identified cause (OR= 1.97 (1.08-3.58)) were independently associated with day-28 mortality after taking into account NIV use within the 2 first days (OR =1.86 (1.22-2.83), p=0.0004), SOFA score without respiratory item at ICU admission (OR=1.17 (1.10-1.25), p<0.001) and PaO2/FiO2 <100 at ICU admission (OR= 1.69 (1.16-2.50), p=0.01). The analyses performed in the validation cohort confirmed the results found in the initial cohort. NIV use, opportunistic or no identified diagnosis and bilateral alveolar radiological pattern were associated with mortality, after taking into account the severity of ARF disease using SOFA score and PaO2/FiO2 ratio.
  • High-flow oxygen therapy vs non invasive ventilation: a prospective cross-over physiological study of alveolar recruitment in acute respiratory failure
    Orateur(s) :
    • Elise Artaud-Macari (Rouen / FRANCE)
    • Michael Bubenheim (Rouen / FRANCE)
    • Gurvan Le Bouar (Rouen / FRANCE)
    • Dorothée Carpentier (Rouen / FRANCE)
    • Steven Grange (Rouen / FRANCE)
    • Déborah Boyer (Rouen / FRANCE)
    • Gaëtan Béduneau (Rouen / FRANCE)
    • Benoit Misset (Rouen / FRANCE)
    • Antoine Cuvelier (Rouen / FRANCE)
    • Fabienne Tamion (Rouen / FRANCE)
    • Christophe Girault (Rouen / FRANCE)
    14h40 / 14h55
    Abstract : High-flow oxygen therapy (HFNC) has shown a benefit for the prognosis of patients with hypoxemic acute respiratory failure (ARF), while noninvasive ventilation (NIV) remains debated in this indication. We evaluated the effect of HFNC on alveolar recruitment and lung volumes in hypoxemic ARF compared to NIV and facial mask (FM).A prospective cross-over physiological study was conducted. Eligible patients had to present a hypoxemic ARF due to pneumonia requiring HFNC and/or NIV according to ICU physician. Cardiogenic pulmonary oedema and underlying respiratory disease were excluded. Each patient was investigated with the Pulmovista® (Dräger, Lübeck, Germany) device and underwent 15 min periods of HFNC or NIV in a randomized order, interspersed with 15 min periods of FM used as reference. The primary endpoint was the comparison of global and regional end-expiratory electrical lung impedance (EELI) between NIV and HFNC. Secondary endpoints were the comparison, between the 3 techniques, of lung volumes (global and regional tidal variations (TV), respiratory parameters, hemodynamic tolerance, dyspnea and comfort.NIV and HFNC significantly increased the global EELI compared with FM (2056 [1070; 2825] vs. 4083 [2928; 5134], p=0.001 and 1448 [1028; 3542] vs 2921 [1706; 4850], p=0.0001, respectively). No global EELI difference was found between NIV and HFNC (4083 [2928; 5134] vs 2921 [1706; 4850], p=0.4) (fig 1.1). Global and regional TV increased under NIV compared to HFNC (p<0.05) or FM (p<0.05), while HFNC did not modify TV over FM. NIV significantly improved the SpO2/FiO2 ratio compared to HFNC (p = 0.001) (fig 1.2). HFNC significantly reduced respiratory rate vs FM (p=0,04) but not NIV. No difference was found for dyspnea score between the 3 techniques. Patient comfort was similar between HFNC and FM but decreased with NIV. This study demonstrates a similar benefit of HFNC and NIV on alveolar recruitment with the settings used, as compared to FM. By contrast to HFNC and despite a better oxygenation, NIV also increases lung volumes which may contribute to its potentially deleterious effect during hypoxemic ARF leading to the recent concept of Patient Self Inflicted Lung Injury or P-SILI (Brochard L et al. AJRCCM 2017;195:438-42).
  • Lung and chest wall mechanics of patients admitted to Intensive Care Unit.
    Orateur(s) :
    • Elise Yvin (Angers / FRANCE)
    • Pierre-Yves Olivier (Angers / FRANCE)
    • Lise Piquilloud (Lausanne / SUISSE)
    • Satar Mortaza (Angers / FRANCE)
    • Alain Mercat (Angers / FRANCE)
    14h55 / 15h10
    Abstract : Data concerning respiratory mechanics of intubated patients separately analyzing the lung and the chest wall are scare. This study aims at describing respiratory mechanics (respiratory system compliance (CRS), lung compliance (CL), chest wall compliance (CCW) and end-expiratory lung volume (EELV)) of all intubated patients admitted to Intensive Care Unit (ICU).This is an interim analysis of a prospective single-center study. All patients admitted to ICU, intubated and paralyzed as part of the routine care, without contraindication to esophageal pressure measurement were included. Respiratory mechanics measurements were performed at their admission to ICU with standardized ventilator settings. CL and CCW were measured using esophageal pressure measurement (Nutrivent catheter, Sidam ®, San Giacomo Roncole, Italy). EELV was measured, at a positive end-expiratory pressure of 5 cmH2O, using the nitrogen washout-washin technique (CRF inview, GE-Healthcare ®, Madison, WI, USA). Results are presented as median [IQR]. Correlations were analyzed using Spearman test. 30 patients were included in the study. ICU admission diagnoses were sepsis other than pulmonary (9 patients, 30%), pneumonia (5 patients, 17%), cardiac arrest (6 patients, 20%), acute cardiac failure (5 patients, 16%) or neurologic disorder (5 patients, 17%). Ten patients (33%) met Acute Respiratory Distress Syndrome criteria at the day of respiratory mechanics measurement. Distributions of CRS, CL and CCW are presented in figure 1. There was a wide distribution of CCW values. CCW impairment (defined as CCW< 100mL/cmH2O) was observed in 7 patients (23%). No clinical history of abdominal hypertension was found in these patients. CCW was not correlated with the body mass index (p=0.21; r=0.24). CL was well correlated with EELV (p<0.001; r=0.80). This study shows that, in a non-selected population of intubated patients admitted to ICU for various reasons, distributions of CL and CCW are wide. CCW impairment is not rare and cannot be predicted by the patient's medical history or morphology. The good correlation between CL and EELV is consistent with data establishing that CL represents the aerated lung volume.
Communications orales
14h10 - 15h10
E07
Médecin : Pédiatrie
Modérateur(s) : Renaud Blondé (Mayotte / FRANCE), Laurent Dupic (Paris / FRANCE)
  • Incidence of ventilatory acquired pneumonia in PICU: a one-year prospective multicenter data-base (the INCIPAVE study)
    Orateur(s) :
    • Stéphane Dauger (Paris / FRANCE)
    • Yves Gallien (Paris / FRANCE)
    • Josephus Van Gestel (Utrecht / PAYS-BAS)
    • Michael Levy (Paris / FRANCE)
    • Astrid Botte (Bordeaux / FRANCE)
    • Fleur Cour-Andlauer (Lyon / FRANCE)
    • Camille Guillot (Lille / FRANCE)
    • Fabrice Lesage (Paris / FRANCE)
    • Catherine Vanbaelen (Toulouse / FRANCE)
    • Maryline Chomton (Paris / FRANCE)
    • Matthieu Resche-Rigon (Paris / FRANCE)
    14h10 / 14h25
    Abstract : Ventilatory Acquired Pneumonia (VAP) is one of the main nosocomial infection in adult ICU. Only one prospective multicenter study performed during six months in 16 PICUs of the US has prospectively described pediatric VAP. We design the INCIPAVE study to report the occurrence of VAP in european PICUs, focusing on patients, risk factors (RF), micro-organisms involved, diagnostic tools and antibiotics used. The first aim of this study was to calculate the incidence of VAP. Multicenter prospective cohort study from 03/04/2017 to 03/04/2018 including all patients mechanically ventilated (MV) at least once in eight PICUs, one in the Netherlands and seven in France. VAP was defined using the 2015 CDC criteria, applied during PICU stays, excluding the 48 hours preceeding and following PICU. Patients were described on admission and main RF ever tested in the medical litterature were daily included by a pediatric intensivist of each PICU in an electronic database on a securized dedicated website. The Ethics Committee of the French Society of Intensive Care approved the study, which has been declared to the CNIL and recorded on Clinical-Trials.org. All parents were individually informed by a dedicated sheet. Descriptive data are reported as number (%) or medians [first-third quartiles]. Incidence was calculated as the number of VAP for 1000 days of MV.These results are based on declarative information reported in the INCIPAVE database during its first opening on September 2018, before cleaning. During one year, 2047 episodes of MV were included in 1856 patients (26.5 months [6;92], 12kgs [6.4;23.22], 56% of males). Main reasons for admission to PICU were post-operative care (35.1%) and respiratory (23.7%), neurological (17.1%) or circulatory (12.2%) failures. PIM-2 score was 2.8% [1.3;7.5] with an observed mortality of 10.9%. PELOD-2 score on day-1 was 5 [4.7]. Patients were ventilated via uncuffed tubes in 19.6% of cases (7.8% of tracheostomy). A total of 158 VAP was declared during 11685 days of MV. The incidence of VAP was 13.5/1000 days of MV (IC95% : [11.4;15.6]).This incidence of VAP in INCIPAVE study is higher than the incidence reported recently by Gupta (7.0/1000 days of MV) (1). New analyses are planned after cleaning of the database, including a special reading of each case of VAP.
  • Severe sepsis and septic shock in hematological pediatric patients admitted to picu : a bicentric retrospective study from 2011 to 2017
    Orateur(s) :
    • Aurélia Alimi (Paris / FRANCE)
    • Julie Sommet (Paris / FRANCE)
    • Sandrine Jean (Paris / FRANCE)
    • Michael Levy (Paris / FRANCE)
    • Maryline Chomton (Paris / FRANCE)
    • Fleur Le Bourgeois (Paris / FRANCE)
    • Stéphane Dauger (Paris / FRANCE)
    14h25 / 14h40
    Abstract : Pediatric sepsis remains a burdensome public health problem, especially in patients with immuno-deficiency. Adherence to Survival Sepsis Campaign (SSC) would be associated with lower mortality. However, this correlation had never been evaluated in children with hematologic malignancies. Retrospective bicentric cohort study of children with identified hematologic malignancy or hematopoietic stem cell transplantation and requiring intensive care for severe sepsis between January 2011 and August 2017. Detailed description of sepsis resuscitation just before and within six hours after the diagnosis of sepsis. Evaluation of adherence to SSC recommandations, before and after admission to Pediatric Intensive Care Unit (PICU). Accurate analysis of microbiologic etiologies. Assessment of mortality 6 months after the sepsis.65 patients were included from the 78 who have been screened. Before admission in ICU : 38% of them did not receive oxygen, 47% of patients showed low blood pressure for age without continuous infusion of inotropes, and lactic acid was measured in few patients (14%). Within 6 hours of PICU admission, 28% did not receive oxygen and only 24% of patients with continuous infusion of inotropes were ventilated. Lactic acid and central venous oxygen saturation measurements were obtained in only one third of patients. An infectious organism was isolated in 51% of patients. The most common primary site of infection was central venous catheter (70%) and 5 patients (13%) showed a fungic infection. The mortality within 6 months was evaluated at 18.5%.Adherence to SCC recommandations for hematologic children with sepsis appeared inadequate. However, mortality was lower in our study than in other previous data. Higher adherence to SSC recommandations for children with hematologic malignancies and better sensitization of medical and nurse staff would be potentially associated with much better prognosis.
  • High-flow nasal canula (HFNC) in infant hospitalized with moderate bronchiolitis: results of a multicenter open-label RCT in pediatric health care (Bronchopti study)
    Orateur(s) :
    • Philippe Durand (Le Kremlin-Bicêtre / FRANCE)
    14h40 / 14h55
    Abstract : HFNC has emerged as a promising method to provide respiratory support in bronchiolitis. Only two RCT had evaluated HFNC in less severe bronchiolitis admitted in general wards but failed to demonstrate a reduction in the length of oxygen therapy or in the proportion of patient transferred in PICU (Kepreotes 2017, Franklin 2018). Therefore, we performed a superiority trial to test the hypothesis that HFNC could reduce the proportion of treatment failure requiring non-invasive ventilation among infants in these setting. Inclusion: first episode of bronchiolitis in infant (less 6 months-old), SpO2 in room air < 95%, m-WCAS score > or =2 and < or =5. Exclusion : urgent need for NIV, mWCAS > 5 or 6, lack of consent. Randomization : standard oxygen therapy (up to 2 L/min)(control) or HFNC (3l/kg/min)(experimental). Cross-over wasn't allowed. Failure criteria: FiO2 > or =40 % or nasal flow oxygen >2L/min to maintain SpO2 target, increasing m-WCAS score or >5-6, refractory apnea and/or increasing PaCO2 at H6. Primary endpoint: proportion of patient in treatment failure requiring non-invasive within 7-days following randomization. Secondary endpoint: percentage admitted in ICU, assessment of short term respiratory status, general ward unit LOS, oxygen and nutritional -support free days. During the 6 months study period (2016-2017), 2630 patients admitted for bronchiolitis into the 17 PED's network were screened of whom 271 underwent randomization (268 in the intention-to-treat analysis) (table 1). HFNC didn't improved the primary outcome. Failure occurred in 21 of 133 patients (15%) in the HFNC group and 27 of 135 (20%) in the control group (OR IC 95%; 0,75 [0,40; 1,40]; p = .36). HFNC didn't reduced the risk of admission in ICU (21 (15%) in HFNC group versus 26 (19%) in control (OR IC 95%; 0,78 [0,41; 1,41]; p = .45). Any patient was intubated. The main reason for treatment failure was the worsening of mWCAS score. Mean LOS on general ward unit was lower in the control group (3,8+/- 2,7 days versus 4,4+/-2,4 days; p=0,04). Short-term assessment of respiratory status didn't shown difference except for mWCAS score and RR in favor HFNC. Three pneumothorax was reported in HFNC group. There was neither evidence of lower rate of non-invasive ventilation support among patients receiving HFNC therapy nor difference in the rate of ICU admission.
  • Prospective bicentric observationnal study of non-invasive ventilation in pediatric acute chest syndrome : the nivipacs cohort
    Orateur(s) :
    • Charlotte Idier (Tours / FRANCE)
    • Julie Sommet (Paris / FRANCE)
    • Julia Guilbert (Paris / FRANCE)
    • Fleur Le Bourgeois (Paris / FRANCE)
    • Jérôme Naudin (Paris / FRANCE)
    • Michael Levy (Paris / FRANCE)
    • Stéphane Dauger (Paris / FRANCE)
    14h55 / 15h10
    Abstract : Acute chest syndrome (ACS) is one of the most frequent and severe manifestations of sickle cell disease in childhood. The physiopathological mechanisms of ACS are complex and resulted in severe abnormalities of ventilation / perfusion ratio. Our hypothesis is that non-invasive ventilation (NIV) could be an important component of ACS treatment. The main objective of this study is to describe the tolerance of NIV in the pediatric ACS.Bicentric prospective study from 01/09/2016 to 01/09/2017, including all sickle cell patients admitted to pediatric intensive care unit (PICU) for ACS. The main composite objective was to describe the tolerance of NIV by identifying the following four components: i) frequency of use, ii) effects on work of breathing evaluated by the clinical respiratory score (CRS), iii) circumstances of NIV weaning, iv) child's comfort scored by the COMFORT scale, and the occurrence of complications.From the thirty-seven children included, 30 (81%) were ventilated with NIV for 34 [22; 53] hours for a duration of stay in PICU of 3.0 [2.0; 4.1] days. All children were discontinuously ventilated in Pressure Support (PS) mode. The CRS dropped rapidly between H0 and H4: from 6 [4; 7] at H0 to 4 [3; 6] at H4 (p = 0.0006), without change in the SpO2 / FIO2 ratio during the same time (385 [320; 463] versus 398 [331; 438], p = 0.25). The COMFORT score was the same with or without NIV. We did not report any NIV complication.The majority of children admitted to PICU with an ACS are broken down into NIV in PS mode. NIV was very well tolerated and was able to decrease respiratory distress in the first hours without modifying oxygen requirement.
Communications orales
14h10 - 15h10
E08
Médecin : Choc septique
Modérateur(s) : Jean-Louis Teboul (Le Kremlin-Bicêtre / FRANCE), Pierre Asfar (Angers / FRANCE)
  • Association between early endotracheal intubation and ICU mortality in septic shock : a prospective multicentric observational study
    Orateur(s) :
    • Sophie Jacquier (Orléans / FRANCE)
    • Agathe Delbove (Nantes / FRANCE)
    • Cédric Darreau (Le Mans / FRANCE)
    • Marjorie Saint-Martin (Le Mans / FRANCE)
    • Frédéric Martino (Pointe-À-Pitre / FRANCE)
    • Jean François Hamel (Angers / FRANCE)
    • Mai-Anh Nay (Orléans / FRANCE)
    • Geoffrey Ledoux (Lille / FRANCE)
    • Ferran Roche-Campo (Barcelone / ESPAGNE)
    • Laurent Camous (Paris / FRANCE)
    • Frédéric Pène (Paris / FRANCE)
    • Thibault Balzer (Brest / FRANCE)
    • François Bagate (CrÉteil / FRANCE)
    • Julien Lorber (La Roche-Sur-Yon / FRANCE)
    • Pierre Bouju (Lorient / FRANCE)
    • Clémence Marois (Paris / FRANCE)
    • Morgane Commereuc (Paris / FRANCE)
    • Matthieu Debarre (Saint-Brieuc / FRANCE)
    • Nicolas Chudeau (Le Mans / FRANCE)
    • Pierre Labroca (Nancy / FRANCE)
    • Karim Merouani (Alençon / FRANCE)
    • Pierre-Yves Egreteau (Morlaix / FRANCE)
    • Vincent Peigne (Chambéry / FRANCE)
    • Caroline Bornstain (Montfermeil / FRANCE)
    • Eddy Lebas (Vannes / FRANCE)
    • Francois Benezit (Rennes / FRANCE)
    • Shazima Vally (Fort-De-France / MARTINIQUE)
    • Sigismond Lasocki (Angers / FRANCE)
    • Alexandre Robert (Nice / FRANCE)
    • Nicolas Lerolle (Angers / FRANCE)
    14h10 / 14h25
    Abstract : By contrast to neurological and respiratory failure, the place for endotracheal intubation and mechanical ventilation is not detailed in guidelines on septic shock, evidencing a lack of dedicated studies. The objective of this study was to assess the association between early endotracheal intubation (before H8 following vasopressor initiation : H0) and outcome (ICU survival) in septic shock patients, taking into account presence or absence of classical intubation criteria (i.e. neurologic and/or respiratory failure).This prospective multicenter observational study was conducted from May 2016 to October 2017 in 32 ICUs (France and Spain). All successive adult patients suffering from septic shock and admitted in participating ICUs were considered. Criteria defining three groups of patients were defined a priori according to the potential neurologic/respiratory motivation of intubation between H0 and H8 : 1) “classical indication group” (CIG) in presence of straightforward indication for endotracheal intubation, 2) “intermediate group”(IG) in presence of moderate impairment, 3) and non-classical motivation group (NCG) in absence of significant impairment. Then, a propensity score was constructed to establish the probability of being intubated. Eight hundred and fifty-nine patients were recruited. Two hundred and twenty-six patients were sorted into the CIG, 329 into the IG and 190 into the NCG. Early intubation was performed in 51% of the CIG, 22% of IG and 9% in NCG. Multivariate analysis showed that groups (CIG>IG>NCG), higher SAPS II and early intubation (OR=1.65 [1.07-1.56]) vs. no early intubation, were independently associated with higher ICU mortality. The propensity score was constructed entering 586 patients. An increased risk of death was observed throughout the range of the propensity score in early intubated patients vs. not early intubated patients, all the more that the propensity score was increased (p<0.001), see figure. In a multivariate analysis, delayed intubation showed no impact on mortality vs. early intubation with OR=0.99 [0.52-1.87] ; p=0.97 for patients intubated between H8-H24 vs. patients intubated before H8 and OR=1.66 [0.76-3.65]; p = 0.21 for patients intubated between H24 and H72. An association between early intubation and higher mortality was observed both in a multivariate model and using a propensity score in septic shock patients. This study opens the way for a prospective interventional trial.
  • VA-ECMO to rescue refractory septic shock with severe myocardial dysfunction
    Orateur(s) :
    • Nicolas Bréchot (Paris / FRANCE)
    • David Hajage (Paris / FRANCE)
    • Julien Demiselle (Angers / FRANCE)
    • Santi Montero (Paris / FRANCE)
    • Matthieu Schmidt (Paris / FRANCE)
    • Guillaume Hékimian (Paris / FRANCE)
    • Guillaume Lebreton (Paris / FRANCE)
    • Charles-Edouard Luyt (Paris / FRANCE)
    • Elie Zogheib (Amiens / FRANCE)
    • Erwan Flecher (Rennes / FRANCE)
    • Daniel Brodie (New-York / ETATS-UNIS)
    • Pierre Asfar (Angers / FRANCE)
    14h25 / 14h40
    Abstract : Some patients with septic shock may develop very severe myocardial dysfunction refractory to medical treatments. Several cohorts and case-report studies reported salvage therapy with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in those patients. The aim of this study was to assess the usefulness of VA-ECMO as rescue therapy during refractory myocardial dysfunction associated with septic shock.In this multicenter international retrospective study, patients from 4 ECMO centers implanted with VA-ECMO as a rescue therapy from 2008 to 2018 for refractory septic shock with severe myocardial dysfunction (cardiac index below 3 L/min/m2 and/or left ventricular ejection fraction below 35%) were included. As controls, 228 patients exhibiting severe myocardial dysfunction during the same period of time but who did not receive ECMO were isolated from 3 large septic shock databases, and were included the first day they met criteria for severe myocardial dysfunction. ECMO and non-ECMO patients outcomes were compared after matching for disease severity. The primary end point was mortality at 90 days.(mean±SD and n (%) are shown) Eighty-two patients rescued with VA-ECMO were included. Patients exhibited extremely severe myocardial dysfunction (mean cardiac index at 1.54±0.54 L/min/m2 and left ventricular ejection fraction 28.1±5.7%), despite very high doses of catecholamines (mean inotropic score 279±247 µg/kg/min). They also had profound lactic acidemia (pH 7.13±0.15 and lactatemia 8.9±4.4 mmol/L) and severe multiple organ failure (SOFA score 16.6±2.9 and SAPS-II score 78.3±16.1). Seventy-eight of them could be matched with non-ECMO patients based on a propensity score for disease severity (lactatemia, cardiac index and SOFA score). Mortality at 90 days was dramatically reduced in matched ECMO patients compared to controls, (41% vs. 87%, p<0.0001). In a sensitivity analysis, all patients with cardiac index monitoring were weighted using matching weight ponderation on inotropic score, lactatemia, SOFA score, age and cardiac index at inclusion. Mortality at 90 days remained significantly reduced in weighted ECMO patients. Finally, survivors in the ECMO group reported acceptable SF-36 evaluated health-related quality of life in the months following ICU discharge. In this retrospective propensity-matched study, rescue therapy with VA-ECMO was associated with a dramatic reduction in 90 days mortality for patients with refractory septic shock and severe myocardial dysfunction.
  • Persistent fluid responsiveness is infrequent after fluid expansion: a multicenter, prospective physiological study
    Orateur(s) :
    • Hélène Beringuer (Paris / FRANCE)
    • Pierre-Eric Danin (Nice / FRANCE)
    • Julien Pottecher (Strasbourg / FRANCE)
    • Florence Fagot-Gandet (Strasbourg / FRANCE)
    • Eliane Albuisson (Vandoeuvre-Les-Nancy / FRANCE)
    • Xavier Monnet (Le Kremlin-Bicêtre / FRANCE)
    • Jean-Louis Teboul (Le Kremlin-Bicêtre / FRANCE)
    • Martin Dres (Paris / FRANCE)
    14h40 / 14h55
    Abstract : Fluid expansion is the first therapeutic option in patients presenting acute circulatory failure but its hemodynamic effects (persistency and time of maximal increase in cardiac output) are unknown. We sought to describe the time course of cardiac output over a 2-hours period after a fluid expansion. Our objectives were 1) to identify patterns of fluid responsiveness and 2) to determine the time of maximal increase in cardiac output during and after fluid expansion.It was a prospective multicentre observational study conducted in four intensive care units. To be included, mechanically ventilated patients with acute circulatory failure (infusion of norepinephrine) had to be equipped with a transpulmonary thermodilution device (PiCCO 2) and a decision of fluid expansion (500 ml of saline over a standardized 10-minutes period) had to be made. Calibration was achieved before and at two hours after fluid expansion. Transpulmonary thermodilution derived indices were collected over the two-hours period of observation. Fluid responsiveness was defined as an increase in cardiac index 15% from the start of the fluid expansion. Four patterns of fluid responsiveness were predefined: never responders, ultrafast responders (before the end of the fluid expansion), short-term responders (at the end of the fluid expansion) and persistent responders (over the 2-hours observation period). No change in drugs dosage nor ventilatory settings were allowed during the study. Fifty-eight patients (79 cases) were included. Septic shock was the main reason of acute circulatory failure (46/58, 79%). Patterns of fluid responsiveness were the followings: non-responders (36/79, 46%), ultrafast responders (3/79, 4%), short-term responders (13/79, 16%) and persistent responders (6/79, 8%). In addition, 21 (27%) patients had hemodynamic instability and required a second fluid expansion during the protocol. No significant difference was found between patterns in terms of baseline hemodynamic characteristics nor drugs administrated. The increase in cardiac output was maximal after 300 [189-411] seconds in never responders, after 516 [396-672] seconds in ultrafast responders, after 456 [360-660] seconds in short-term responders and after 348 [315-372] seconds in persistent responders. Persistent fluid responsiveness occurred in a minority of patients presenting acute circulatory failure. Maximal increase in cardiac output could be observed during fluid expansion between 5 and 10 minutes.
  • Molar Sodium Lactate Improves Mesenteric MicroCirculation, Cardiac Function, Capillary Leakage and Inflammation in a Rat Sepsis Model
    Orateur(s) :
    • Emmanuel Besnier (Rouen / FRANCE)
    • David Coquerel (Sherbrooke / CANADA)
    • Geoffrey Kouadri (Rouen / FRANCE)
    • Mathieu Soulié (Rouen / FRANCE)
    • Nicolas Perzo (Rouen / FRANCE)
    • Raphael Favory (Lille / FRANCE)
    • Thibault Duburcq (Lille / FRANCE)
    • Olivier Lesur (Sherbrooke / CANADA)
    • Soumeya Bekri (Rouen / FRANCE)
    • Vincent Richard (Rouen / FRANCE)
    • Paul Mulder (Rouen / FRANCE)
    • Fabienne Tamion (Rouen / FRANCE)
    14h55 / 15h10
    Abstract : Fluids composed of molar sodium lactate have recently been identified as beneficial in endotoxinic animal models1. The objective of our work was to evaluate the effects of molar sodium lactate on micro- and macro-circulation, capillary leakage and different biological parameters in a sepsis rat model of caecal ligation and puncture (CLP).We realized CLP in 30 rats randomized in 3 groups (n=10 per group): Sham; CLP-NaCl 0.9%; CLP-Lactate 11.2%. Immediately after CLP, fluids were infused intravenous (2.5 mL/kg/h) during 18 hours. Then, we evaluated mesenteric microcirculation (laser speckle imager), cardiac function (echocardiography) and inflammation (uremia, albuminemia, VEGF-A, IL-1β, IL-10, TNFα). Assay of capillary leakage using Blue Evans extravasation in the lung and gut were realized on additional rats (n=5/group). Results are expressed as medians with interquartiles and comparisons versus CLP-NaCl were realized using Kruskall-Wallis or ANOVA test.Mesenteric microcirculation was lower in CLP-NaCl vs. Sham (240.6 [209.3-390.8] vs. 935.9 [855.0-1067.0] pixels/unit, p<0.0001) and CLP-Lactate (735.5 [407.4-878.8], p=0.0006). CLP-NaCl rats presented a lower cardiac output vs. Sham (0.14 [0.10-0.18] vs. 0.30 [0.26-0.34] mL/min/g, p=0.004) and CLP-lactate (0.34 [0.28-0.43], p<0.0001) and lower left ventricular shortening fraction vs. CLP-Lactate (39.1 [32.9-51.8] vs. 55.2 [46.2-73.2] %, p=0.009). There was no difference concerning albuminemia, left ventricular diastolic diameter, central venous pressure or E/A mitral flow ratio between CLP-NaCl and CLP-lactate, suggesting comparable volemia. Mean arterial pressure between CLP-NaCl and CLP-Lactate was similar at the end of infusion. Evans Blue diffusion was reduced in the gut and the lung for CLP-lactate (37.2 [31.0-43.3] vs. 112.7 [63.3-141.6] and 107.5 [82-174.3] vs. 272.7 [221.8-444.5] ng EB/mg of tissue). Plasma levels of lactate and 3OH-butyrate were higher in CLP-lactate vs. CLP-NaCl (6.03 [3.08-10.3] vs. 3.19 [2.42-5.11] mmol/L, p=0.04; 400 [174-626] vs. 189 [130-301] µmol/L, p=0.03), but no difference for plasma pyruvate or acetoacetate. Inflammatory response was reduced in CLP-lactate (IL-1β: 172.2 [119.0-446.3] vs. 927.7 [244.8-1470] pg/mL, p=0.004; TNFα: 17.9 [12.5-50.3] vs. 53.9 [30.8-85.6] pg/mL, p=0.005; IL-10: 351.6 [267.0-918.6] vs. 904.5 [723.1-1243] pg/mL) as well as VEGA-A plasma levels (198.2 [185.3-250.0] vs. 260.7 [249.8-268.9] pg/mL, p=0.009). No difference was observed for syndecan plasma level. We demonstrate for the first time that molar lactate fluid perfusion protects against CLP-induced cardiovascular dysfunction, mesenteric microvascular alteration and capillary leakage, in association with a significant reduction in inflammatory process. These results suggest that molar lactate fluid perfusion may be an attractive target for the treatment of sepsis.