Papers by Xavier Capdevila
Anesthesia & Analgesia, 2020
BACKGROUND: Nerve damage can occur after peripheral nerve block (PNB). Ultrasound guidance does n... more BACKGROUND: Nerve damage can occur after peripheral nerve block (PNB). Ultrasound guidance does not eliminate the risk of intraneural injection or nerve injury. Combining nerve stimulation and injection pressure (IP) monitoring with ultrasound guidance has been suggested to optimize needle tip location in PNB. In this prospective observational study, we hypothesized that measured pairs of IP and minimum intensity of stimulation (MIS) might differentiate successive needle tip locations established by high-resolution ultrasound during PNB. METHODS: For this exploratory study, 240 observations for 40 ultrasound-guided PNBs were studied in 28 patients scheduled for orthopedic surgery. During the progression of the needle to the nerve observed by ultrasonography, the IP was measured continuously using a computerized pressure-sensing device with a low flow rate of solution. Stimulation thresholds and electrical impedance were obtained by an impedance analyzer coupled to the nerve stimulat...
BMC Infectious Diseases, 2019
Background: We report a rare case of anaerobic vertebral osteomyelitis associated with surgical t... more Background: We report a rare case of anaerobic vertebral osteomyelitis associated with surgical tracheotomy which has never been reported to the best of our knowledge. Case presentation: A healthy 39-year-old man was admitted to intensive care for a severe brain trauma injury where a surgical tracheotomy was performed. He was discharged to a rehabilitation centre after 54 days hospital stay. During rehabilitation, he developed progressive and febrile tetraplegia associated with cervical pain, requiring an intensive care readmission. A polymicrobial anaerobic bloodstream infection was revealed and magnetic resonance imaging diagnosed cervical vertebral osteomyelitis. Both the type of anaerobic microorganisms found and the timing of the symptoms strongly suggest that the surgical tracheotomy was responsible for this rare case of cervical vertebral osteomyelitis. The patient was successfully treated by a prolonged antimicrobial therapy and by surgical laminectomy. Conclusions: Tracheotomy may generate anaerobic bacteraemia and related osteomyelitis in the specific setting of severe trauma patients. Clinicians should consider anaerobic vertebral osteomyelitis when they are confronted with a febrile tetraplegia after tracheotomy.
Transfusion, Jan 29, 2018
Early identification of acute traumatic coagulopathy is a key challenge during initial management... more Early identification of acute traumatic coagulopathy is a key challenge during initial management to determine whether to initiate early hemostatic support. We assessed the performance of prothrombin time (PT) at point-of-care in trauma patients to detect moderate and severe coagulopathy on admission. All admitted consecutive trauma patients were analyzed retrospectively between April 2014 and July 2015. PT was measured on admission with both a PT point-of-care device (PTr-CGK) and a standard coagulation test (PTr-STD). The results for PTr-CGK and PTr-STD were compared using analysis of agreement, precision, and accuracy. The diagnostic performance of PTr-CGK to predict coagulopathy was established by analysis of receiver operating characteristic curves. The predictive performance of different thresholds and risk factors for misclassification were also studied. Over a 16-month period, 522 patients were included. PTr-CGK estimated PTr-STD with a bias of 0.00 (95% confidence interval ...
Annales Françaises d'Anesthésie et de Réanimation, 2014
Injury, Jan 15, 2017
Liberal late fluid management (LFM) is associated with higher morbi-mortality in critically ill p... more Liberal late fluid management (LFM) is associated with higher morbi-mortality in critically ill populations. The aim of the study was to assess the association between LFM and duration of mechanical ventilation in a severe trauma population. A retrospective analysis of consecutive patients with an ISS≥16 and a length of stay in the intensive care unit (ICU)≥7 days was performed. The conservative LFM group included patients with at least 2 consecutive days with a negative fluid balance between day 3 and day 7; other patients were allocated to the liberal LFM group. 294 severely injured patients were included, 157 (53%) as conservative LFM and 137 (47%) as liberal LFM. The groups did not differ significantly in terms of baseline characteristics, severe injuries, severity criteria or transfusion needs. Liberal LFM was significantly associated with more ventilation days (11 vs 8.5days; P=0.02), less ventilator-free days at day 30 (19 vs 21days; P=0.03), longer ICU stay (19 vs 16days; P=...
Anesthésie & Réanimation, 2015
Introduction La fenetre frontale (F Front ) en doppler transcrânien (DTC), connue chez l’enfant [... more Introduction La fenetre frontale (F Front ) en doppler transcrânien (DTC), connue chez l’enfant [1] , a ete recemment decrite chez l’adulte [2] . Elle ameliore le taux de detection de l’artere cerebrale anterieure (ACA) en complement de la fenetre temporale (F Temp ) [3] . L’objectif etait d’evaluer la faisabilite et de valider la performance diagnostique de la F Front en reanimation. Patients et methodes Dans deux reanimations du CHU de Montpellier, tous les patients neuroleses hospitalises ont beneficie dans les 72 premieres heures d’un examen standardise par DTC, par F Temp puis par F Front . L’examen par FFront ( Fig. 1 ) etait repete par un second operateur en aveugle. La proportion de patients echogenes par F Front a ete determinee ainsi que la reproductibilite intra- et inter-observateur (coefficient Kappa). Pour les patients echogenes par F Front et F Temp , la concordance entre les mesures effectuees sur l’ACA a ete specifiquement evaluee (biais, dispersion). L’etude a recu l’avis favorable du comite de protection des personnes. Resultats Soixante-huit patients ont ete inclus entre novembre 2014 et avril 2015, âge moyen 51 ± 6 ans, 66 % d’hommes, Glasgow 6 ± 1, IGS2 44 ± 5. Dix-huit d’entre eux (26 %) etaient atteints de traumatisme crânien, 15 (22 %) d’accident vasculaire cerebral, 11 (16 %) d’intoxication medicamenteuse, 9 (13 %) de syndrome post-ressuscitation, 7 (10 %) d’hemorragie meningee. La proportion de patients echogenes par F Front etait de 49 % (IC 95 % 36 %–60 %) versus 69 % par F Temp (IC 95 % 61 %–77 %). La F Front etait la seule fenetre permettant des mesures sur l’ACA chez 7 patients (10 %). Les mesures des velocites (V) de l’ACA etaient en moyenne plus faibles par F Front que par F Temp : V systolique (VSyst) 79 ± 4 vs 96 ± 7 cm/s, V moyenne (VMoy) 44 ± 3 vs 52 ± 4 cm/s, index de pulsatilite (IP) 1,17 ± 0,05 vs 1,26 ± 0,08, respectivement. Le coefficient Kappa intra-observateur etait de 1 (IC 95 % 0,83–1,16) et inter-observateur de 0,75 (IC 95 % 0,58–0,92). Chez les patients echogenes par F Front et F Temp , les biais moyens de mesure et dispersions moyennes correspondantes etait de −12,6 cm/s (± 36,4 cm/s) pour la VSyst, −5,3 cm/s (± 20,2 cm/s) pour la VMoy et −0,07 (± 0,33) pour l’IP. Discussion Il s’agit de la premiere etude decrivant la F Front en reanimation. La F Front a permis l’evaluation des velocites de l’ACA chez 49 % des patients, et etait la seule fenetre permettant des mesures sur l’ACA chez 10 % des patients. La reproductibilite etait correcte, probablement perfectible avec le developpement de la technique. Le manque de concordance observe entre les mesures par F Front et F Temp est probablement lie au fait que la F Front explore l’ACA dans un segment plus distal que la F Temp . En pratique, la F Front a deux applications cliniques : elle est une technique alternative d’examen chez les patients pour qui la F Temp n’est pas contributive, et elle complete l’examen temporal pour l’evaluation segmentaire des velocites sur l’ACA, utile chez les patients a risque de vasospasme.
Annales Françaises d'Anesthésie et de Réanimation, 2013
PloS one, 2016
Prediction of massive transfusion (MT) is challenging in management of trauma patients. However, ... more Prediction of massive transfusion (MT) is challenging in management of trauma patients. However, MT and its prediction were poorly studied in obese patients. The main objective was to assess the relationship between obesity and MT needs in trauma patients. The secondary objectives were to validate the Trauma Associated Severe Hemorrhage (TASH) score in predicting MT in obese patients and to use a grey zone approach to optimize its ability to predict MT. An observational retrospective study was conducted in a Level I Regional Trauma Center Trauma in obese and non-obese patients. MT was defined as ≥10U of packed red blood cells in the first 24h and obesity as a BMI≥30kg/m². Between January 2008 and December 2012, 119 obese and 791 non-obese trauma patients were included. The rate of MT was 10% (94/910) in the whole population. The MT rate tended to be higher in obese patients than in non-obese patients: 15% (18/119, 95%CI 9‒23%) versus 10% (76/791, 95%CI 8‒12%), OR, 1.68 [95%CI 0.97‒2...
European Journal of Anaesthesiology, 2004
(11 g/dl), thrombocytopenia (68000/mm3), elevated lactate dehydrogenase (LDH) (4572 IU/L), hyperb... more (11 g/dl), thrombocytopenia (68000/mm3), elevated lactate dehydrogenase (LDH) (4572 IU/L), hyperbilirubinemia (2,5 mg/dl) and elevated serum creatinine (1,89 mg/dl). TM was confirmed by the presence of schizocytes and a decrease in haptoglobine levels. Few hours after, she suddenly developed acute respiratory distress syndrome associated to elevated creatine kinase and troponine-I levels. An electrocardiogram showed elevated ST segments in leads I, aVL, V4, V5 and V6. Echocardiography indicated akinetic right ventricular wall. A coronarography did not shown any coronary disease. Despite the placement of intra-aortic balloon, fresh-frozen plasma, fluids and pressors, she died 12 hours after admission. At autopsy, the diagnosis of widespread myocardial TM was confirmed. Results and Discussions: As illustrated in this case, TM is associated to high LDH levels, hyperbilirubinemia and low haptoglobine levels. In TM, ischemia of the brain and gastrointestinal tract is common. While cardiac involvement is commonly seen at autopsy, clinical cardiac dysfunction is rare. To our knowledge, only two cases of widespread ischemic cardiac disease have been described in the literature. Conclusion(s): Anemia associated to thrombocytopenia and high levels of lactate dehydrogenase must evoke the diagnosis of TM. Although clinical cardiac dysfunction is rare, widespread acute myocardial infraction can occur.
Anesthesia & Analgesia, 2021
European Journal of Anaesthesiology, 2021
Advances in Therapy, 2019
Introduction: This observational study was designed to assess the use of spinal anesthesia with c... more Introduction: This observational study was designed to assess the use of spinal anesthesia with chloroprocaine in the context of ambulatory surgery. Methods: A prospective, multicenter, observational study was carried out among 33 private or public centers between May 2014 and January 2015 and adult patients, scheduled for a short ambulatory surgery under spinal anesthesia with chloroprocaine. The primary outcomes were anesthetic effectiveness, defined as performance of the whole surgical procedure without any additional anesthetic agent, and the time to achieve eligibility for hospital discharge. Secondary outcomes were the effect of chloroprocaine on motor and sensory blocks, patients' satisfaction, and the use of analgesics in the first 24 h after surgery. Results: Among the 615 enrolled patients, 56% were male, the mean age was 47.2 ± 15.2 years, and most patients had an ASA (American Society of Anesthesiologists) status of 1 (63.7%). Main surgical procedures performed were orthopedic (62.6%) and gynecologic (16.1%), and the mean duration of surgery was 26.7 ± 16.7 min. The overall anesthetic success rate was 93.8% (95% CI [91.5%; 95.6%]) for the 580 patients with available data for primary criteria. The failure rate was lower than 7% for all surgical procedures, except for gynecologic surgery (14.8%; 95% CI [8.1%; 23.9%]). The average times of eligibility for hospital discharge and effective discharge were 252.7 ± 82.7 min and 313.8 ± 109.9 min, Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.11213033.
Advances in Therapy, 2019
Introduction: Available short-acting intrathecal anesthetic agents (chloroprocaine and prilocaine... more Introduction: Available short-acting intrathecal anesthetic agents (chloroprocaine and prilocaine) offer an alternative to general anesthesia for short-duration surgical procedures, especially ambulatory surgeries. Factors determining the choice of anesthesia for short-duration procedures have not been previously identified. Methods: This observational, prospective, multicenter, cohort study was conducted between July 2015 and July 2016, in 33 private or public hospitals performing ambulatory surgery. The primary objective was to determine the factors influencing the choice of anesthetic technique (spinal or general anesthesia). Secondary outcomes included efficacy of the anesthesia, time to hospital discharge, and patient satisfaction. Results: Among 592 patients enrolled, 309 received spinal anesthesia and 283 underwent general anesthesia. In both study arms, the most frequently performed surgical procedures were orthopedic and urologic (43.3% and 30.7%, respectively); 66.1% of patients were free to choose their type of anesthesia, 21.8% chose one of the techniques because they were afraid of the other, 16.8% based their choice on the expected ease of recovery, 19.2% considered their degree of anxiety/stress, and 16.9% chose the technique on the basis of its efficacy. The median times to micturition and to unassisted ambulation were significantly shorter in the general anesthesia arm compared with the Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.11210276.
Annals of Intensive Care, 2016
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Papers by Xavier Capdevila