Browsing by Author "Azoulay, Elie"
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- ItemExpert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method(2021) Nasa, Prashant; Azoulay, Elie; Khanna, Ashish K.; Jain, Ravi; Gupta, Sachin; Javeri, Yash; Juneja, Deven; Rangappa, Pradeep; Sundararajan, Krishnaswamy; Bakker, JanAbstract Background Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice. Methods Using a Delphi process, an international panel of 39 experts developed clinical practice statements on the respiratory management of C-ARF in areas where evidence is absent or limited. Agreement was defined as achieved when > 70% experts voted for a given option on the Likert scale statement or > 80% voted for a particular option in multiple-choice questions. Stability was assessed between the two concluding rounds for each statement, using the non-parametric Chi-square (χ2) test (p < 0·05 was considered as unstable). Results Agreement was achieved for 27 (73%) management strategies which were then used to develop expert clinical practice statements. Experts agreed that COVID-19-related acute respiratory distress syndrome (ARDS) is clinically similar to other forms of ARDS. The Delphi process yielded strong suggestions for use of systemic corticosteroids for critical COVID-19; awake self-proning to improve oxygenation and high flow nasal oxygen to potentially reduce tracheal intubation; non-invasive ventilation for patients with mixed hypoxemic-hypercapnic respiratory failure; tracheal intubation for poor mentation, hemodynamic instability or severe hypoxemia; closed suction systems; lung protective ventilation; prone ventilation (for 16–24 h per day) to improve oxygenation; neuromuscular blocking agents for patient-ventilator dyssynchrony; avoiding delay in extubation for the risk of reintubation; and similar timing of tracheostomy as in non-COVID-19 patients. There was no agreement on positive end expiratory pressure titration or the choice of personal protective equipment. Conclusion Using a Delphi method, an agreement among experts was reached for 27 statements from which 20 expert clinical practice statements were derived on the respiratory management of C-ARF, addressing important decisions for patient management in areas where evidence is either absent or limited. Trial registration: The study was registered with Clinical trials.gov Identifier: NCT04534569.
- ItemThe Sequential Organ Failure Assessment (SOFA) Score: has the time come for an update?(2023) Moreno, Rui; Rhodes, Andrew; Piquilloud, Lise; Hernández P., Glenn; Takala, Jukka; Gershengorn, Hayley B.; Tavares, Miguel; Coopersmith, Craig M.; Myatra, Sheila N.; Singer, Mervyn; Rezende, Ederlon; Prescott, Hallie C.; Soares, Márcio; Timsit, Jean-François; de Lange, Dylan W.; Jung, Christian; De Waele, Jan J.; Martin, Greg S.; Summers, Charlotte; Azoulay, Elie; Fujii, Tomoko; McLean, Anthony S.; Vincent, Jean-Louis; Pontificia Universidad Católica de Chile. Departamento de Medicina Intensiva, Facultad de MedicinaThe Sequential Organ Failure Assessment (SOFA) score was developed more than 25 years ago to provide a simple method of assessing and monitoring organ dysfunction in critically ill patients. Changes in clinical practice over the last few decades, with new interventions and a greater focus on non-invasive monitoring systems, mean it is time to update the SOFA score. As a first step in this process, we propose some possible new variables that could be included in a SOFA 2.0. By so doing, we hope to stimulate debate and discussion to move toward a new, properly validated score that will be fit for modern practice.
- ItemTime-limited trial of intensive care treatment: an overview of current literature(2018) Vink, Eva E.; Azoulay, Elie; Caplan, Arthur; Kompanje, Erwin J. O.; Bakker, Jan
- ItemYear in review in Intensive Care Medicine 2013: II. Sedation, invasive and noninvasive ventilation, airways, ARDS, ECMO, family satisfaction, end-of-life care, organ donation, informed consent, safety, hematological issues in critically ill patients(2014) Azoulay, Elie; Citerio, Giuseppe; Bakker, Jan; Bassetti, Matteo; Benoit, Dominique; Cecconi, Maurizio; Curtis, J. Randall; Hernández P., Glenn; Herridge, Margaret; Jaber, Samir