Cardiovascular Life Support Therapies

Diagnostic
Diagnosing cardiac dysfunction is often challenging in ICU particularly in septic patients.  We have been working on the use of biomarkers such as natriuretic peptides (B-type natriuretic peptide) in this context. We showed that, despite useful in cardiology, such biomarkers were worthless in septic ICU patients. Indeed we showed in a study published in Critical Care Medicine that during sepsis, the plasmatic concentrations of B-type natriuretic peptide raise even without cardiac dysfunction, because of an alteration in their degradation pathway. Specifically, we showed that the endopeptidase NEP 24.11 activity was extremely depressed in septic shock patients.
Treatment
I have been working on different aspects of the treatment of cardiac failure. We evaluated the use of Continuous Positive Airway Pressure (CPAP) in pre-hospital settings in patients treated for acute cardiogenic pulmonary edema and showed that a short course of CPAP could be associated with significant improvement in patients’ outcomes. This has been published in the European Heart Journal. However, in a more recent work, we have shown that CPAP was not associated with hospital mortality in a population of patients admitted in the ICU for an acute cardiogenic pulmonary edema (Journal of Cardiac Failure). In the ICU, we have been working on the optimal regimen of catecholamine to administer to patients treated for cardiogenic shock. We showed that associating inodilators to inopressors could decrease ICU mortality in this context.

Monitoring
We are currently working on some innovative, non-invasive tools that could help monitoring the micro-circulation under pharmacological or mechanical support in shock patents.



​Prognosis
My interest in the prognosis of patients treated in Anesthesiology/Intensive Care lead me to work on the specific question of the benefit of ICU admission in the elderly. I participated as the French investigator in the ELDICUS study, an international, multicenter observational study endorsed by the European Commission, which aimed at evaluating the prognosis of all patients proposed for ICU admission, whether or not they were accepted. We were able to offer very interesting and worth descriptions of the population of patients proposed for ICU across Europe. Specifically, we showed the absence of interaction between ICU admission and patients’ age on mortality.  Besides the fact that ICU cares might be useful whatever the age, the question of whether elderly patients wish to be resuscitated is still of interest. I worked on this topic as well.
 

My second focus in the area of prognosis is to provide innovative tools for predicting ICU mortality. I recently developed a new prediction algorithm for mortality prediction in ICU patients. A link to the SICULA is available below: 
 

http://webapps.biostat.berkeley.edu:8080/sicula/



Optimization of Daily ICU Care

I have been working on different aspects of daily cares in the ICU, especially those related to the prevention and the diagnosis of ICU-related infectious complications, such as catheter infection or ventilator associated pneumonia.