The optimal intake of artificial nutrition in critically ill patients remains unclear. While calorie and protein intakes affect glomerular function in patients with chronic kidney disease, their relation to renal function at the acute phase of intensive care is insufficiently documented. We aimed to study associations of a low-calorie and low-protein diet with renal outcomes in critically ill patients. This post hoc analysis of the NUTRIREA-3 randomized-controlled trial included 3036 mechanically ventilated patients with shock. Calorie and protein intakes during the first 7 days were either low (6 kcal/kg and 0.2–0.4 g protein/kg/d) or standard (25 kcal/kg and 1.0–1.3 g protein/kg/d). The primary outcome was the incidence of acute kidney disease (AKD) during the ICU stay (up to ICU discharge or day 90 after inclusion, whichever occurred first). AKD during the ICU stay occurred in 669 (44.6
Introduction: The central Pyrenees form the natural border between France and Spain and attract many outdoor enthusiasts. Cross-border mountain rescues are frequent, yet their medical and logistical consequences remain poorly described. We aimed to determine the number of cross-border rescue victims and assess their hospital pathways, satisfaction, and practical difficulties during care abroad. Methods: We conducted a retrospective two-center study (RESCAPYR study) in 2021, including all consecutive cross-border mountain rescue patients from 2018 to 2019 (N = 150). Follow-up telephone interviews were conducted between 2022 and 2023 with patients who were referred to hospitals following the rescue operation to assess satisfaction and self-reported difficulties. Data were obtained from rescue and hospital records. Categorical variables were compared using the chi-square or Fisher’s exact test, continuous variables using the Mann–Whitney U test, and paired satisfaction scores using the Wilcoxon signed-rank test. Results: In France, 54 Spanish nationals were rescued over two years (5.1–5.6% of annual rescues). In Spain, 96 French nationals were rescued in the same period (12.0–17.2%). Approximately two-thirds required hospitalization in the neighboring country. Median hospital stay was 2 days [1–4] for Spanish patients and 1 day [1–2] for French patients. Satisfaction significantly decreased between the prehospital and hospital phases (P = 0.01 and P < 0.01), in both groups. Patients from both countries reported similar difficulties, mainly language barriers, financial concerns, and repatriation challenges. Conclusion: Cross-border mountain rescues frequently result in hospitalization outside patients’ national healthcare systems and expose them to administrative and communication barriers. Improved cross-border coordination and structured emergency transfer agreements are needed in border regions.
Introduction Les biothérapies sont des traitements innovants qui contribuent à la réduction de la prise de corticoïdes ainsi que leurs effets secondaires, les exacerbations, la dyspnée, et l’amélioration de la qualité de vie chez des patients présentant un asthme sévère. L’objectif de ce travail est de décrire les caractéristiques des patients asthmatiques sévères sous biothérapies à partir des données de la cohorte française Palomb asthme sévère. Méthodes Cohorte prospective multicentrique. Recrutement depuis 2019 et suivi en vie réelle des patients issus de 2 régions (Aquitaine et Charentes) par des pneumologues (indépendants ou hospitaliers). Critères d’inclusion : ≥18 ans ; >6 mois de suivi pour asthme sévère (GINA 2019) ; CSI-LABA et LAMA, associés ou non avec CSO, anti-Ige, anti-IL5, anti-RIL5, anti-IL4, anti-IL13, thermoplastie bronchique. Résultats En juillet 2024, 301 patients étaient inclus. 61,1 % étaient des femmes et l’âge moyen était de 54,4 ans. Au total, 153 patients (50,8 %) avaient déjà un traitement par biothérapie, 54 (17,9 %) ont eu un traitement par biothérapie introduit et 94 (31,2 %) n’étaient pas sous biothérapie. Les biothérapies prescrites chez les patients sous traitements sont (n=207) : 27,5 % omalizumab, 15,9 % mepolizumab, 28,5 % benralizumab, 22,7 % dupilumab et 1,0 % tezepelumab (4,3 % non renseignées). Les patients déjà sous biothérapie étaient plus sous omalizumab (32,0 % vs 14,8 %) tandis que les patients avec une biothérapie introduite étaient plus sous dupilumab (38,9 % vs 17,0 %). Les patients avec une biothérapie introduite avaient également plus d’exacerbations (≥2), de dyspnée (mMRC≥2), de sifflements et d’obstruction nasale comparés aux patients ayant déjà une biothérapie ou ceux sans biothérapie. Conclusion Une majorité de patients avec un asthme sévère ont un traitement par biothérapie. Les patients avec une biothérapie introduite à l’inclusion ont un profil clinique de l’asthme sévère plus symptomatique que les patients déjà sous traitement ou sans biothérapie.
Critical-illness survivors may experience post-traumatic stress disorder (PTSD) and quality-of-life impairments. Resilience may protect against psychological trauma but has not been adequately studied after critical illness. We assessed resilience and its associations with PTSD and quality of life, and also identified factors associated with greater resilience. This prospective, multicentre, study in patients recruited at 41 French ICUs was done in parallel with the NUTRIREA-3 trial in patients given mechanical ventilation and vasoactive amines for shock. Three months to one year after intensive-care-unit admission, survivors completed the Connor-Davidson Resilience Scale (CD-RISC-25), Impact of Event-Revised scale for PTSD symptoms (IES-R), SF-36 quality-of-life scale, Multidimensional Scale of Perceived Social Support (MSPSS), and Brief Illness Perception Questionnaire (B-IPQ). Of the 382 included patients, 203 (53.1
BackgroundIMAGE is a retrospective cohort study of patients enrolled in early access programs (EAPs) in France with relapsed/refractory multiple myeloma (RRMM) receiving isatuximab with pomalidomide and dexamethasone (Isa-Pd).MethodsPatients aged >= 18 years with RRMM who received >= 1 dose of Isa under the EAPs between July 29, 2019 and August 30, 2020 were included. Effectiveness endpoints included progression-free survival (PFS) and response rates. Verbatim terms for adverse events (AEs) were coded using the Medical Dictionary for Regulatory Activities and not graded for severity.ResultsA total of 294 and 299 patients were included in the effectiveness and safety populations, respectively. IMAGE included patients who received one prior line of treatment (10.2%) and were daratumumab-refractory (19.1%). At median follow-up of 14.2 months, median PFS in the effectiveness population was 12.4 months (95% CI 9.0-15.0). Overall response and very good partial response rates were 46.3% and 27.9%, respectively. Subgroup analyses reflected similar results. In the safety population, 26.4% of patients reported at least one AE; the most common any-grade AE was neutropenia (9.4%).ConclusionIMAGE demonstrated Isa-Pd had meaningful effectiveness in median PFS and depth of response and no new safety signals in a real-world context, consistent with clinical trial results. image
