Laurence Dangers
University of Paris
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Featured researches published by Laurence Dangers.
Intensive Care Medicine | 2014
Matthieu Schmidt; Robert B. Banzett; Mathieu Raux; Capucine Morélot-Panzini; Laurence Dangers; Thomas Similowski; Alexandre Demoule
BackgroundIntensive care unit (ICU) patients are exposed to many sources of discomfort. Although increasing attention is being given to the detection and treatment of pain, very little is given to the detection and treatment of dyspnea (defined as “breathing discomfort”).MethodsPublished information on the prevalence, mechanisms, and potential negative impacts of dyspnea in mechanically ventilated patients are reviewed. The most appropriate tools to detect and quantify dyspnea in ICU patients are also assessed. Results/ConclusionsGrowing evidence suggests that dyspnea is a frequent issue in mechanically ventilated ICU patients, is highly associated with anxiety and pain, and is improved in many patients by altering the ventilator settings.ConclusionsFuture studies are needed to better delineate the impact of dyspnea in the ICU and to define diagnostic, monitoring and therapeutic protocols.
Chest | 2015
Guillaume Dumas; Guillaume Geri; Claire Montlahuc; Sarah Chemam; Laurence Dangers; Claire Pichereau; Nicolas Brechot; Matthieu Duprey; Julien Mayaux; Maleka Schenck; Julie Boisramé-Helms; Guillemette Thomas; Loredana Baboi; Luc Mouthon; Zair Amoura; Thomas Papo; Alfred Mahr; Sylvie Chevret; Jean-Daniel Chiche; Elie Azoulay
BACKGROUND Patients with systemic rheumatic diseases (SRDs) may require ICU management for SRD exacerbation or treatment-related infections or toxicities. METHODS This was an observational study at 10 university-affiliated ICUs in France. Consecutive patients with SRDs were included. Determinants of ICU mortality were identified through multivariable logistic analysis. RESULTS Three hundred sixty-three patients (65.3% women; median age, 59 years [interquartile range, 42-70 years]) accounted for 381 admissions. Connective tissue disease (primarily systemic lupus erythematosus) accounted for 66.1% of SRDs and systemic vasculitides for 26.2% (chiefly antineutrophil cytoplasm antibodies-associated vasculitides). SRDs were newly diagnosed in 43 cases (11.3%). Direct admission to the ICU occurred in 143 cases (37.9%). Reasons for ICU admissions were infection (39.9%), SRD exacerbation (34.4%), toxicity (5.8%), or miscellaneous (19.9%). Respiratory involvement was the leading cause of admission (56.8%), followed by shock (41.5%) and acute kidney injury (42.2%). Median Sequential Organ Failure Assessment (SOFA) score on day 1 was 5 (3-8). Mechanical ventilation was required in 57% of cases, vasopressors in 33.9%, and renal replacement therapy in 28.1%. ICU mortality rate was 21.0% (80 deaths). Factors associated with ICU mortality were shock (OR, 3.77; 95% CI, 1.93-7.36), SOFA score at day 1 (OR, 1.19; 95% CI, 1.10-1.30), and direct admission (OR, 0.52; 95% CI, 0.28-0.97). Neither comorbidities nor SRD characteristics were associated with survival. CONCLUSIONS In patients with SRDs, critical care management is mostly needed only in patients with a previously known SRD; however, diagnosis can be made in the ICU for 12% of patients. Infection and SRD exacerbation account for more than two-thirds of these situations, both targeting chiefly the lungs. Direct admission to the ICU may improve outcomes.
Critical Care Medicine | 2017
Laurence Dangers; Nicholas Bréchot; Matthieu Schmidt; Guillaume Lebreton; Guillaume Hékimian; Ania Nieszkowska; Sébastien Besset; Jean-Louis Trouillet; Jean Chastre; Pascal Leprince; Alain Combes; Charles-Edouard Luyt
Objective: Long-term outcomes of patients treated with venoarterial-extracorporeal membrane oxygenation for acute decompensated heart failure (i.e., cardiogenic shock complicating chronic cardiomyopathy) have not yet been reported. This study was undertaken to describe their outcomes and determine mortality-associated factors. Design: Retrospective analysis of data prospectively collected. Setting: Twenty-six–bed tertiary hospital ICU. Patients: One hundred five patients implanted with venoarterial-extracorporeal membrane oxygenation for acute decompensated heart failure. Intervention: None. Measurements and Main Results: From March 2007 to January 2015, 105 patients were implanted with venoarterial-extracorporeal membrane oxygenation for acute decompensated heart failure in our ICU (67% of them had an intraaortic balloon pump to unload the left ventricle). Their 1-year survival rate was 42%; most of the survivors were transplanted either directly or after switching to central bilateral centrifugal pump, ventricular-assist device, or total artificial heart. Most deaths occurred early after multiple organ failure. Multivariable analyses retained (odds ratio [95% CI]) pre–extracorporeal membrane oxygenation Sequential Organ Failure Assessment score of more than 11 (3.3 [1.3–8.3]), idiopathic cardiomyopathy (0.4 [0.2–1]), cardiac disease duration greater than 2 years pre–extracorporeal membrane oxygenation (2.8 [1.2–6.9]), and pre–extracorporeal membrane oxygenation blood lactate greater than 4 mmol/L (2.6 [1.03–6.4]) as independent predictors of 1-year mortality. Only 17% of patients with pre–extracorporeal membrane oxygenation Sequential Organ Failure Assessment scores of 14 or more survived, whereas 52% of those with scores less than 7 and 60% of those with scores 7 or more and less than 11 were alive 1 year later. Conclusions: Among this selected cohort of 105 patients implanted with venoarterial-extracorporeal membrane oxygenation for acute decompensated heart failure, 1-year survival was 42%, but better for patients with pre–extracorporeal membrane oxygenation Sequential Organ Failure Assessment scores of less than 11. Venoarterial-extracorporeal membrane oxygenation should be considered for patients with acute decompensated heart failure, but timing of implantation is crucial.
Thorax | 2017
Laurence Dangers; Louis Laviolette; Marjolaine Georges; Jésus Gonzalez-Bermejo; Isabelle Rivals; Thomas Similowski; Capucine Morélot-Panzini
Background Dyspnoea is a threatening sensation of respiratory discomfort that presents many similarities with pain. Experimental dyspnoea in healthy subjects induces analgesia. This ‘dyspnoea-pain counter-irritation’ could, in reverse, imply that relieving dyspnoea in patients with chronic respiratory diseases would lower their pain thresholds. Methods We first determined pressure pain thresholds in 25 healthy volunteers (22–31 years; 13 men; handheld algometer), during unloaded breathing (BASELINE) and during inspiratory threshold loading (ITL). Two levels of loading were used, adjusted to induce dyspnoea self-rated at 60% or 80% of a 10 cm visual analogue scale (ITL6 and ITL8). 18 patients with chronic respiratory failure due to amyotrophic lateral sclerosis (ALS) were then studied during unassisted breathing and after 30 and 60 min of non-invasive ventilation—NIV30 and NIV60—(same dyspnoea evaluation). Results In healthy volunteers, pressure pain thresholds increased significantly in the deltoid during ITL6 (p<0.05) and ITL8 (p<0.05) and in the trapezius during ITL8 (p<0.05), validating the use of pressure pain thresholds to study dyspnoea-pain counter-irritation. In patients with ALS, the pressure pain thresholds measured in the deltoid during unassisted breathing decreased by a median of 24.5%–33.0% of baseline during NIV30 and NIV60 (p<0.05). Conclusion Relieving dyspnoea by NIV in patients with ALS having respiratory failure is associated with decreased pressure pain thresholds. Clinical implications have yet to be determined, but this observation suggests that patients with ALS could become more susceptible to pain after the institution of NIV, hence the need for reinforced attention towards potentially painful diagnostic and therapeutic interventions.
European Respiratory Journal | 2017
Capucine Morélot-Panzini; Dan Adler; Bernard Aguilaniu; Étienne Allard; Nathalie Bautin; Marc Beaumont; François-Xavier Blanc; Cécile Chenivesse; Laurence Dangers; Christophe Delclaux; Alexandre Demoule; Philippe Devillier; Alain Didier; Marjolaine Georges; B. Housset; Jean-Paul Janssens; Pierantonio Laveneziana; Louis Laviolette; Jean-François Muir; Grégory Ninot; Thierry Perez; Claudine Peiffer; Matthieu Schmidt; Thomas Similowski; Christian Straus; Camille Taillé; Sandra Van den Broecke; Nicolas Roche
In the May 2017 issue of the European Respiratory Journal (ERJ), Johnson et al. [1] proposed the term “chronic breathlessness syndrome” to describe the clinical situation in which “breathlessness that persists despite optimal treatment of the underlying pathophysiology and results in disability for the patient”. The term “disability” in this definition corresponds to “physical limitations and/or a variety of adverse psychosocial, spiritual or other consequences”, which very closely matches the World Health Organization definition of the word [2]. The relationship between breathlessness and disability was well captured in the foreword of a document published in 2013 by the Forum of International Respiratory Societies [3], which begins: “When we are healthy, we take our breathing for granted […]. But when our lung health is impaired, nothing else but our breathing really matters”. This has become the “catch phrase” of the French lung health foundation (“Fondation du Souffle”, www.lesouffle.org). The explicit definition of “chronic breathlessness” as proposed by Johnson et al. [1] differs very little from the implicit definition of “refractory breathlessness”, the term previously used in many studies, and which was proposed as a distinct entity by some of the authors of a previously published ERJ article [4]. Johnson et al. [1] submit that defining and naming this new syndrome will improve the visibility of a distressing and debilitating condition that is too often overlooked and neglected [5]. They postulate that this enhanced visibility will result in improved care and organisation of care, stronger research [6], and greater empowerment for patients and their caregivers. The Editorial by Başoğlu [7] published in the May 2017 issue of the ERJ throws new light on this notion of empowerment. Making a daring but fascinating parallel between untreated dyspnoea and torture, Başoğlu [7] reminds us how and why addressing dyspnoea in general (and probably “chronic breathlessness” in particular) is a fundamental issue not only from the point of view of medicine per se, but also from the point of view of human rights (on this, see also [8]). He also makes a very convincing case for the importance of empowerment in the management of dyspnoea. Still in the same issue of the ERJ, Calverley [9] comments on the new syndrome and, like us, concurs with Johnson et al. [1] about the relevance of making breathlessness a foremost concern of every clinician. Despite maximal pathophysiological treatment, persistent dyspnoea is a distinct entity, be it chronic or acute http://ow.ly/7cR530equaI
European Respiratory Journal | 2018
Laurence Dangers; Claire Montlahuc; Achille Kouatchet; Samir Jaber; Ferhat Meziani; Sébastien Perbet; Thomas Similowski; Matthieu Resche-Rigon; Elie Azoulay; Alexandre Demoule
Dyspnoea is a frequent and intense symptom in intubated patients, but little attention has been paid to dyspnoea during noninvasive mechanical ventilation in the intensive care unit (ICU). The objectives of this study were to quantify the prevalence, intensity and prognostic impact of dyspnoea in patients receiving noninvasive ventilation (NIV) for acute respiratory failure (ARF) based on secondary analysis of a prospective observational cohort study in patients who received ventilatory support for ARF in 54 ICUs in France and Belgium. Dyspnoea was measured by a modified Borg scale. Among the 426 patients included, the median (interquartile range) dyspnoea score was 4 (3–5) on admission and 3 (2–4) after the first NIV session (p=0.001). Dyspnoea intensity ≥4 after the first NIV session was associated with the Sequential Organ Failure Assessment Score (odds ratio (OR) 1.12, p=0.001), respiratory rate (OR 1.03, p=0.032), anxiety (OR 1.92, p=0.006), leaks (OR 2.5, p=0.002) and arterial carbon dioxide tension (OR 0.98, p=0.025). Dyspnoea intensity ≥4 was independently associated with NIV failure (OR 2.41, p=0.001) and mortality (OR 2.11, p=0.009), but not with higher post-ICU burden and altered quality of life. Dyspnoea is frequent and intense in patients receiving NIV for ARF and is associated with a higher risk of NIV failure and poorer outcome. Dyspnoea is frequent in patients who receive NIV in the ICU and is associated with a poorer outcome http://ow.ly/sh3Z30kaieo
BMJ Open | 2018
Arnaud W. Thille; Grégoire Muller; Arnaud Gacouin; Rémi Coudroy; Alexandre Demoule; Romain Sonneville; François Beloncle; Christophe Girault; Laurence Dangers; Alexandre Lautrette; Séverin Cabasson; Anahita Rouzé; Emmanuel Vivier; Anthony Le Meur; Jean-Damien Ricard; Keyvan Razazi; Guillaume Barberet; Christine Lebert; Stephan Ehrmann; Walter Picard; Jeremy Bourenne; Gael Pradel; Pierre Bailly; Nicolas Terzi; Matthieu Buscot; Guillaume Lacave; Pierre-Eric Danin; Hodanou Nanadoumgar; Aude Gibelin; Lassane Zanre
Introduction Recent practice guidelines suggest applying non-invasive ventilation (NIV) to prevent postextubation respiratory failure in patients at high risk of extubation failure in intensive care unit (ICU). However, such prophylactic NIV has been only a conditional recommendation given the low certainty of evidence. Likewise, high-flow nasal cannula (HFNC) oxygen therapy has been shown to reduce reintubation rates as compared with standard oxygen and to be as efficient as NIV in patients at high risk. Whereas HFNC may be considered as an optimal therapy during the postextubation period, HFNC associated with NIV could be an additional means of preventing postextubation respiratory failure. We are hypothesising that treatment associating NIV with HFNC between NIV sessions may be more effective than HFNC alone and may reduce the reintubation rate in patients at high risk. Methods and analysis This study is an investigator-initiated, multicentre randomised controlled trial comparing HFNC alone or with NIV sessions during the postextubation period in patients at high risk of extubation failure in the ICU. Six hundred patients will be randomised with a 1:1 ratio in two groups according to the strategy of oxygenation after extubation. The primary outcome is the reintubation rate within the 7 days following planned extubation. Secondary outcomes include the number of patients who meet the criteria for moderate/severe respiratory failure, ICU length of stay and mortality up to day 90. Ethics and dissemination The study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals. Trial registration number NCT03121482.
Revue Des Maladies Respiratoires | 2016
Laurence Dangers; Thomas Similowski; Cécile Chenivesse
BACKGROUND When pleural procedures (thoracocentesis, blind pleural biopsies and chest tube insertion) are required in patients taking long-term platelet aggregation inhibitors, the risk of bleeding must be balanced against the risk of arterial thrombosis. Currently, the bleeding risk of pleural procedures is poorly understood. OBJECTIVE The objective of the survey was to gather the opinion of respiratory physicians regarding the bleeding risk of pleural procedures in patients taking platelet aggregation inhibitors. METHODS We emailed a standardized questionnaire designed by the French National Authority for Health to 2697 French respiratory physicians. RESULTS One hundred and eighty-eight of the 2697 questionnaires were returned (response rate: 7 %). The respiratory physicians declared that they performed an average of 8 pleural procedures per month. One hundred and seventy-five responders (95 %) practised pleural procedures in patients receiving platelet aggregation inhibitors; 68 of them (39 %) reported experiencing haemorrhagic complications. The bleeding risk associated with thoracentesis and chest tube insertion was considered minor by 97.8 and 65 % of responders respectively, whereas it was considered major for blind pleural biopsies by 73.4 %. Respiratory physicians were more reticent about performing pleural procedures in patients treated with clopidogrel than in those taking aspirin. CONCLUSION This study provides an overview of how respiratory physicians perceive the bleeding risk associated with pleural procedures in patients taking platelet aggregation inhibitors.
Intensive Care Medicine Experimental | 2015
Martin Dres; Bruno-Pierre Dubé; Laurence Dangers; Mayaux J; Thomas Similowski; Alexandre Demoule
Sepsis and mechanical ventilation are both risk factors of diaphragmatic dysfunction (DD) in critically ill patients. The evolution of diaphragmatic function under mechanical ventilation in septic and non-septic patients has not been described.
Pulmonary Pharmacology & Therapeutics | 2016
Laurence Dangers; Louis Laviolette; Beny Charbit; Thomas Similowski; Capucine Morélot-Panzini