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Search Results: 1 - 10 of 330146 matches for " Fabio S Taccone "
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Continuous infusion of meropenem in critically ill patients: practical considerations
Fabio Taccone
Critical Care , 2012, DOI: 10.1186/cc11459
Abstract: First, the doses of meropenem used by Chytra and colleagues could be largely criticized. The authors have already underlined how the CI strategy received a lower daily regimen than the bolus strategy (4 g/day vs. 6 g/day) and the use of such an approach showed only clinical equivalence with but not superiority to II in clinical trials [3]. More importantly, the II group was treated with higher than recommended daily regimens (2 g every 8 hours rather than 1 g every 8 hours). In severe sepsis and septic shock, a 1 g loading dose of meropenem resulted in optimal serum concentrations to treat pathogen with a minimal inhibitory concentration (MIC) of 2 μg/ml in 75% of patients, while it provided adequate drug levels for lower MICs in all patients [4]. The same results were shown for both loading and steady-state doses when serum and subcutaneous drug levels were measured [5]. Calculating the doses of meropenem on population pharmacokinetic models from patients without critically illness may thus under estimate antibiotic concentrations measured in real populations and result in unnecessarily high drug regimens. Future research should therefore consider standard drug regimens (1 g every 8 hours) as a valuable control for CI strategies in septic patients.Second, the CI group received 4 g meropenem over 24 hours, aiming to reach 100% of the time that drug concentrations would be above the MIC (T>MIC) for most Gram-negative pathogens. Nevertheless, carbapenems need only 40% T>MIC to have bactericidal effects, because of the significant post-antibiotic effect and enhanced leucocyte activity shown in in vitro models [6]. As such, prolonging the infusion of meropenem over 3 hours between two administrations would be sufficient to maximize its antibacterial activity [3]. Clearly, further clinical investigations are needed to better identify the optimal T>MIC to use when CI of β-lactams is given during life-threatening infections.Third, because the median MIC of the pathogens wa
Effects of changes in arterial pressure on organ perfusion during septic shock
Aurélie Thooft, Rapha?l Favory, Diamantino Salgado, Fabio S Taccone, Katia Donadello, Daniel De Backer, Jacques Creteur, Jean-Louis Vincent
Critical Care , 2011, DOI: 10.1186/cc10462
Abstract: This was a single center, prospective, interventional study conducted in the medico-surgical intensive care unit of a university hospital. Thirteen patients in septic shock for less than 48 hours who required NE administration were included. NE doses were adjusted to obtain MAPs of 65, 75, 85 and (back to) 65 mmHg. In addition to hemodynamic and metabolic variables, we measured thenar muscle oxygen saturation (StO2), using near infrared spectroscopy (NIRS), with serial vaso-occlusive tests (VOTs) on the upper arm. We also evaluated the sublingual microcirculation using sidestream dark field (SDF) imaging in 6 of the patients.Increasing NE dose was associated with an increase in cardiac output (from 6.1 to 6.7 l/min, P<0.05) and mixed venous oxygen saturation (SvO2, from 70.6 to 75.9%, P<0.05). Oxygen consumption (VO2) remained stable, but blood lactate levels decreased. There was a significant increase in the ascending slope of StO2 (from 111 to 177%/min, P<0.05) after VOTs. SDF imaging showed an increase in perfused vessel density (PVD, from 11.0 to 13.2 n/mm, P<0.05) and in microvascular flow index (MFI, from 2.4 to 2.9, P<0.05).In this series of patients with septic shock, increasing MAP above 65 mmHg with NE was associated with increased cardiac output, improved microvascular function, and decreased blood lactate concentrations. The microvascular response varied among patients suggesting that individualization of blood pressure targets may be warranted.Septic shock is characterized by an alteration in tissue perfusion associated with persistent arterial hypotension - generally defined as a systolic arterial pressure of less than 90 mm Hg [1] - despite adequate fluid resuscitation [2]. This leads to organ dysfunction and even death in around 50% of cases [3]. Evaluation of systemic hemodynamic variables can be inadequate to identify tissue perfusion, which is directly influenced by additional microvascular factors. De Backer and colleagues [4] showed that sepsis
Characteristics and outcomes of cancer patients in European ICUs
Fabio Taccone, Antonio A Artigas, Charles L Sprung, Rui Moreno, Yasser Sakr, Jean-Louis Vincent
Critical Care , 2009, DOI: 10.1186/cc7713
Abstract: This was a substudy of the Sepsis Occurrence in Acutely Ill Patients (SOAP) study, a cohort, multicentre, observational study that included data from all adult patients admitted to one of 198 participating ICUs from 24 European countries during the study period. Patients were followed up until death, hospital discharge or for 60 days.Of the 3147 patients enrolled in the SOAP study, 473 (15%) had a malignancy, 404 (85%) had solid tumours and 69 (15%) had haematological cancer. Patients with solid cancers had the same severity of illness as the non-cancer population, but were older, more likely to be a surgical admission and had a higher frequency of sepsis. Patients with haematological cancer were more severely ill and more commonly had sepsis, acute lung injury/acute respiratory distress syndrome, and renal failure than patients with other malignancies; these patients also had the highest hospital mortality rate (58%). The outcome of all cancer patients was comparable with that in the non-cancer population, with a 27% hospital mortality rate. However, in the subset of patients with more than three failing organs, more than 75% of patients with cancer died compared with about 50% of patients without cancer (p = 0.01).In this large European study, patients with cancer were more often admitted to the ICU for sepsis and respiratory complications than other ICU patients. Overall, the outcome of patients with solid cancer was similar to that of ICU patients without cancer, whereas patients with haematological cancer had a worse outcome.Remarkable advances have been made in the early diagnosis and aggressive management of patients with malignancies, resulting in dramatic improvements in overall survival rates [1,2]. As a result, increasing numbers of patients are admitted to the intensive care unit (ICU), either for cancer-related complications or for treatment-associated side effects [3]. Several studies have reported very high mortality rates for cancer patients after a
Cerebral oximetry during extracorporeal cardiopulmonary resuscitation
Fabio Taccone, David Fagnoul, Benoit Rondelet, Jean-Louis Vincent, Daniel de Backer
Critical Care , 2013, DOI: 10.1186/cc11929
Abstract: Brain damage remains the most important cause of morbidity and mortality among survivors after cardiac arrest. However, it remains unclear how systemic hemodynamics should be adjusted to ensure adequate cerebral oxygenation. Cerebral oximetry has been used to optimize cerebral perfusion during conventional CPR [1], and very low cerebral saturation (<40%) may predict poor neurological outcomes at hospital discharge in patients with OHCA [2]. ECMO has been shown to be effective to resuscitate adult patients following refractory cardiac arrest with intact neurological outcomes in 15% to 30% of cases [3,4]. Nevertheless, only scarce data are available on the adequacy of cerebral oxygenation during eCPR, and most of them focus on pediatric patients. In one retrospective study, Wong and colleagues [5] described their experience with cerebral oximetry monitoring in 20 adult patients with ECMO; in this population, low cerebral saturation occurred in all patients and was corrected in 80% of them by various interventions to optimize brain perfusion, including increasing MAP or ECMO blood flow [5]. In our patient, cerebral saturation remained very low during CPR and only just exceeded 40% with initial ECMO settings, and both of these factors probably were implicated in the irreversible brain damage.We suggest that cerebral oximetry be used to rapidly adjust ECMO blood flow to provide adequate brain oxygenation in patients undergoing eCPR. The impact of such an approach on outcomes warrants further evaluation.CPR: cardiopulmonary resuscitation; ECMO: extracorporeal membrane oxygenation; eCPR: extracorporeal cardiopulmonary resuscitation; MAP: mean arterial pressure; OHCA: out-of-hospital cardiac arrest; PaO2: arterial partial oxygen pressure; StO2' tissue hemoglobin saturation.The authors declare that they have no competing interests.DF, DdB, and BR were directly involved in the medical management of the patient. FST was responsible for cerebral oximetry monitoring. All authors
Urea for treatment of acute SIADH in patients with subarachnoid hemorrhage: a single-center experience
Charalampos Pierrakos, Fabio Silvio Taccone, Guy Decaux, Jean-Louis Vincent, Serge Brimioulle
Annals of Intensive Care , 2012, DOI: 10.1186/2110-5820-2-13
Abstract: This is a retrospective analysis of all patients admitted to our department for nontraumatic SAH between January 2003 and December 2008 (n?=?368). All patients with SIADH-induced hyponatremia (plasma sodium?<?135 mEq/L, urine sodium?>?20 mEq/L, and osmolality?>?200 mOsm/kg; absence of overt dehydration or hypovolemia; no peripheral edema or renal failure; no history of adrenal or thyroid disease) routinely received urea per os when hyponatremia was associated with clinical deterioration or remained less than 130 mEq/L despite saline solution administration.Forty-two patients developed SIADH and were treated with urea. Urea was started after a median of 7 (IQR, 5–10) days and given orally at doses of 15–30 g tid or qid for a median of 5 (IQR, 3–7) days. The median plasma sodium increase over the first day of treatment was 3 (IQR, 1–6) mEq/L. Hyponatremia was corrected in all patients, with median times to Na+ >130 and >135 mEq/L of 1 (IQR, 1–2) and 3 (IQR, 2–4) days, respectively. Urea was well tolerated, and no adverse effects were reported.Oral urea is an effective and well-tolerated treatment for SIADH-induced hyponatremia in SAH patients.
Intra-arrest hypothermia during cardiac arrest: a systematic review
Sabino Scolletta, Fabio Taccone, Per Nordberg, Katia Donadello, Jean-Louis Vincent, Maaret Castren
Critical Care , 2012, DOI: 10.1186/cc11235
Abstract: We performed a systematic search of PubMed, EMBASE, CINAHL, the Cochrane Library and Ovid/Medline databases using "arrest" OR "cardiac arrest" OR "heart arrest" AND "hypothermia" OR "therapeutic hypothermia" OR "cooling" as keywords. Only studies using intra-arrest therapeutic hypothermia (IATH) were selected for this review. Three authors independently assessed the validity of included studies and extracted data regarding characteristics of the studied cohort (animal or human) and the main outcomes related to the use of IATH: Mortality, neurological status and cardiac function (particularly, rate of ROSC).A total of 23 animal studies (level of evidence (LOE) 5) and five human studies, including one randomized controlled trial (LOE 1), one retrospective and one prospective controlled study (LOE 3), and two prospective studies without a control group (LOE 4), were identified. IATH improved survival and neurological outcomes when compared to normothermia and/or hypothermia after ROSC. IATH was also associated with improved ROSC rates and with improved cardiac function, including better left ventricular function, and reduced myocardial infarct size, when compared to normothermia.IATH improves survival and neurological outcome when compared to normothermia and/or conventional hypothermia in experimental models of CA. Clinical data on the efficacy of IATH remain limited.Use of mild therapeutic hypothermia, or "targeted temperature management" as recently suggested [1], has been recommended in cardiac arrest (CA) patients since the publication of two randomized clinical trials in 2002, the results of which demonstrated a significant improvement in neurologically intact survival for comatose CA patients presenting with ventricular fibrillation (VF) or ventricular tachycardia (VT) [2,3]. Current guidelines suggest that mild therapeutic hypothermia should also be considered in patients presenting with other rhythms although this has been less well studied [4].Although therap
Microcirculatory alterations: potential mechanisms and implications for therapy
Daniel De Backer, Katia Donadello, Fabio Taccone, Gustavo Ospina-Tascon, Diamantino Salgado, Jean-Louis Vincent
Annals of Intensive Care , 2011, DOI: 10.1186/2110-5820-1-27
Abstract: Sepsis is associated with high mortality. Multiple mechanisms may contribute to sepsis-associated organ dysfunction, which is related to altered tissue perfusion, especially in the early stages, and to direct alterations in cellular metabolism. The importance of rapid correction of perfusion abnormalities has lead to the concept of early goal-directed therapy, which has been shown to improve the outcome of patients with septic shock [1]. However, even when global hemodynamics are optimized, alterations in the microcirculation can still be present and can contribute to perfusion alterations [2]. Indeed, the microcirculation is responsible for fine-tuning tissue perfusion and adapting it to metabolic demand. Experimental and, more recently with development of new techniques that allow direct visualization of the microcirculation [3], clinical evidence indicate that microcirculatory alterations occur in severe sepsis and septic shock and that these alterations may play a role in the development of organ dysfunction. In this review, we will discuss the relevance of these sepsis-associated microcirculatory alterations, the mechanisms involved in their development and potential therapies.Several methods can be used to evaluate microcirculation in septic patients [3]. Two techniques are currently used to evaluate microcirculation at bedside: Sidestream Sark Field imaging technique (SDF) and near infrared spectroscopy (NIRS). SDF is a small handheld microscope that illuminates the field by light reflection from deeper layers. Vessels are visualized as the selected wavelength is absorbed by the hemoglobin contained in the red blood cells.Orthogonal Polarization Spectral imaging technique (OPS) was based on a similar principle but is no longer available. The technique is limited by the fact that it can only be applied on superficial tissues covered by a thin epithelium (mostly the sublingual area) and it requires collaboration or sedation of the patient. In addition, great ca
Cerebral microcirculation is impaired during sepsis: an experimental study
Fabio Silvio Taccone, Fuhong Su, Charalampos Pierrakos, Xinrong He, Syril James, Olivier Dewitte, Jean-Louis Vincent, Daniel De Backer
Critical Care , 2010, DOI: 10.1186/cc9205
Abstract: Fifteen anesthetized, invasively monitored, and mechanically ventilated female sheep were allocated to a sham procedure (n = 5) or sepsis (n = 10), in which peritonitis was induced by intra-abdominal injection of autologous faeces. Animals were observed until spontaneous death or for a maximum of 20 hours. In addition to global hemodynamic assessment, the microcirculation of the cerebral cortex was evaluated using Sidestream Dark-Field (SDF) videomicroscopy at baseline, 6 hours, 12 hours and at shock onset. At least five images of 20 seconds each from separate areas were recorded at each time point and stored under a random number to be analyzed, using a semi-quantitative method, by an investigator blinded to time and condition.All septic animals developed a hyperdynamic state associated with organ dysfunction and, ultimately, septic shock. In the septic animals, there was a progressive decrease in cerebral total perfused vessel density (from 5.9 ± 0.9 at baseline to 4.8 ± 0.7 n/mm at shock onset, P = 0.009), functional capillary density (from 2.8 ± 0.4 to 2.1 ± 0.7 n/mm, P = 0.049), the proportion of small perfused vessels (from 95 ± 3 to 85 ± 8%, P = 0.02), and the total number of perfused capillaries (from 22.7 ± 2.7 to 17.5 ± 5.2 n/mm, P = 0.04). There were no significant changes in microcirculatory flow index over time. In sham animals, the cerebral microcirculation was unaltered during the study period.In this model of peritonitis, the cerebral microcirculation was impaired during sepsis, with a significant reduction in perfused small vessels at the onset of septic shock. These alterations may play a role in the pathogenesis of septic encephalopathy.Sepsis and septic shock still represent major health issues, with persisting high morbidity and mortality rates in critically ill patients [1]. Sepsis is associated with tissue hypoperfusion and metabolic impairment, which may contribute to the associated multiple organ failure [2]. Cerebral dysfunction occurs comm
Recommended β-lactam regimens are inadequate in septic patients treated with continuous renal replacement therapy
Lucie Seyler, Frédéric Cotton, Fabio Taccone, Daniel De Backer, Pascale Macours, Jean-Louis Vincent, Frédérique Jacobs
Critical Care , 2011, DOI: 10.1186/cc10257
Abstract: This open, prospective study enrolled consecutive patients treated with CRRT and receiving either meropenem (MEM), piperacillin-tazobactam (TZP), cefepime (FEP) or ceftazidime (CAZ). Serum concentrations of these antibiotics were determined by high-performance liquid chromatography from samples taken before (t = 0) and 1, 2, 5, and 6 or 12 hours (depending on the β-lactam regimen) after the administration of each antibiotic. Series of measurements were separated into those taken during the early phase (< 48 hours from the first dose) of therapy and those taken later (> 48 hours).A total of 69 series of serum samples were obtained in 53 patients (MEM, n = 17; TZP, n = 16; FEP, n = 8; CAZ, n = 12). Serum concentrations remained above four times the minimal inhibitory concentration for Pseudomonas spp. for the recommended time in 81% of patients treated with MEM, in 71% with TZP, in 53% with CAZ and in 0% with FEP. Accumulation after 48 hours of treatment was significant only for MEM.In septic patients receiving CRRT, recommended doses of β-lactams for Pseudomonas aeruginosa are adequate for MEM but not for TZP, FEP and CAZ; for these latter drugs, higher doses and/or extended infusions should be used to optimise serum concentrations.Severe sepsis and septic shock are major causes of morbidity and mortality in ICUs [1-3]. Antibiotic treatment, if adequate and given early [4,5], remains of paramount importance to optimise chances of survival [6]. Several studies have shown the crucial impact of the first 24 hours of antimicrobial treatment on outcome [7]. In addition to timing, the chosen antibiotic should target the potential pathogens involved, taking local susceptibility patterns into account. To be effective, the doses given should reach therapeutic concentrations in the blood and at the site of infection [8-10]. Sepsis can significantly alter the pharmacokinetics of antimicrobials and result in subtherapeutic drug concentrations [11,12], potentially contributing to
Ampullary Neuroendocrine Tumor: A Rare Cause of Recurrent Abdominal Pain  [PDF]
Andrew Ofosu, Michael Taccone, Laskhmi Potakamuri, Sanjay Jagannath
Case Reports in Clinical Medicine (CRCM) , 2014, DOI: 10.4236/crcm.2014.33034
Abstract:

Ampullary Neuroendocrine tumor (ANET) is a rare GI malignancy, representing less than 1% of GI neuroendocrine tumors and less than 2% of ampullary tumors. Traditional treatment is often a pancreaticoduodenectomy; however, local and endoscopic resections have been successful. We report a rare case of ANET in a 21-year-old Burmese man who presented with a 6-year history of non-specific intermittent abdominal pain who was successfully managed through transduodenal ampullectomy. At 24 months postoperatively he remains disease and symptom free. ANET is a rare cause of recurrent abdominal pain, and local excision of small ANETs can be an alternative, less morbid treatment for young patients. We follow the case with a brief review of the literature.

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