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See detailClinical course and challenging management of early COVID-19 infection after heart transplantation: case report of two patients
TCHANA-SATO, Vincent ULiege; ANCION, Arnaud ULiege; TRIDETTI, Julien ULiege et al

in BMC Infectious Diseases (2021)

Background: There are limited data on Coronavirus disease 2019 (COVID-19) in solid organ transplant patients, especially in heart transplant recipients, with only a few case reports and case series ... [more ▼]

Background: There are limited data on Coronavirus disease 2019 (COVID-19) in solid organ transplant patients, especially in heart transplant recipients, with only a few case reports and case series described so far. Heart transplant recipients may be at particular high risk due to their comorbidities and immunosuppressed state. Case presentation: This report describes the clinical course and the challenging management of early COVID-19infection in two heart transplant recipients who tested positive for the SARS-CoV-2 virus in the perioperative period of the transplant procedure. The two patients developed a severe form of the disease and ultimately died despite the initiation of an antiviral monotherapy with hydroxychloroquine coupled with the interruption of mycophenolate mofetil. Conclusions: These two cases illustrate the severity and poor prognosis of COVID-19 in the perioperative period of a heart transplant. Thorough screening of donors and recipients is mandatory, and the issue of asymptomatic carriers needs to be addressed. [less ▲]

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See detailIn-Parallel Ventilator Sharing during an Acute Shortage: Too Much Risk for a Wider Uptake
Chase, J Geoffrey ULiege; Chiew, Yeong Shiong ULiege; LAMBERMONT, Bernard ULiege et al

in American Journal of Respiratory and Critical Care Medicine (2020)

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See detailTranslating A Risk-Based Glycaemic Control Framework for Critically Ill Patients: STAR-Liège
Uyttendaele, Vincent ULiege; Knopp, Jennifer L.; PIROTTE, Marc ULiege et al

in IFAC-PapersOnLine (2020, July)

Glycaemic control (GC) in the intensive care unit (ICU) has been widely debated over the last 20 years. While many studies showed benefits, many others failed to replicate the results, blaming the ... [more ▼]

Glycaemic control (GC) in the intensive care unit (ICU) has been widely debated over the last 20 years. While many studies showed benefits, many others failed to replicate the results, blaming the increased related risk of hypoglycaemia. Current ICU guidelines thus often suggest higher glycaemic target ranges, led by the fear of hypoglycaemia – permissive hyperglycaemia. However, recent studies have shown improved safety and performance in GC outcome, using model-based computerised methods. The Stochastic-Targeted (STAR) framework is a patient-specific risk-based dosing protocol modulating insulin and nutrition. This study presents recent intermediate results of the STAR-Liège clinical trial, targeting 4.4-8.0 mmol/L glycaemic band. Clinical data from patients controlled under STAR and STAR insulin only (STAR-IO) are compared to retrospective data under the standard protocol (SP), targeting higher 5.6-8.3 mmol/L glycaemic ranges. Overall, STAR performance was significantly higher (88% blood glucose measurements in the 4.4-8.0 mmol/L or 80-145 mg/dL target band) compared to STAR-IO (78%) and SP (55%). Incidence of hypoglycaemia was similar (1% below target), while hyperglycaemia was much higher for SP (31% above target) compared to STAR (9%) and STAR-IO (11%). The resulting lower median blood glucose (BG) levels in STAR (6.5 mmol/L), compared to STAR-IO (6.7 mmol/L) and SP (7.7 mmol/L), was achieved with less variability, but required higher clinical workload for STAR (12 measurements per day) compared to SP (7 measurements per day). Compliance to protocol was higher for STAR (98%) compared to STAR-IO (90%) and SP (79%). Although targeting lower glycaemic ranges, STAR provided better GC compared to the SP. Typically, the full version of STAR also modulating nutrition, was able to better control extremely insulin resistant patients, further improving glycaemic control results. The results of this clinical trial indicate the capability to provide the safe, effective control for all patients required to improve outcomes. [less ▲]

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See detailModel-Based Weaning Tests for VA-ECLS Therapy
Habran, Simon; Desaive, Thomas ULiege; MORIMONT, Philippe ULiege et al

in Computational and Mathematical Methods in Medicine (2020), 2020

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See detailStochastic TARgeted (STAR) glycaemic control: improved performances and safety for all
Uyttendaele, Vincent ULiege; Knopp, Jennifer L.; PIROTTE, Marc ULiege et al

Poster (2020, January 07)

Rationale: Whether more intensive glycemic control (GC) is beneficial or harmful for critically ill patient has been debated over the last decades. GC has been shown hard to achieve safely and effectively ... [more ▼]

Rationale: Whether more intensive glycemic control (GC) is beneficial or harmful for critically ill patient has been debated over the last decades. GC has been shown hard to achieve safely and effectively in intensive care. The associated increased hypoglycemia and glycemic variability is associated with worsened outcomes. However, model-based risk-based dosing approach have recently shown potential benefits, improving significantly GC safety and performances. Objective: The Stochastic TARgeted (STAR) GC framework is a model-based controller using a unique risk-based dosing approach. STAR identifies model-based patient-specific insulin sensitivity and assesses its potential variability over the next hours. These predictions are used to assess hypoglycemic risks associated with a specific insulin and/or nutrition intervention to reach a specific target band. This study analyzes preliminary clinical trial results of STAR in a Belgian ICU compared to the local standard protocol (SP). Patients and Methods: Ethics approval was granted by the local University Hospital Ethics Committee. Patient are included if two BG measurements > 145 mg/dL. STAR target band is 80-145 mg/dL compared to 100-150mg/dL for the SP. Nutrition is administered enterally, and insulin infusion intra-venously. GC is stopped if BG is stable (6 hours in target band) or after 72 hours of control. Safety is assessed by %BG <80mg/dL and %BG >180 mg/dL. Performance is assessed by %BG in target band. Clinical data from 10 patients is used and compared to 20 retrospective patients under the SP. Results: STAR outperformed the SP. Results summary is presented in Table 1. Despite the lower BG target, STAR safety was improved with lower %BG<80mg/dL (0.5% vs. 1%), and significantly lower %BG>145 mg/dL (11% vs. 44%) and %BG>180mg/dL (2% vs 13%). STAR was highly effective with 89% BG in target band compared to 54% for the SP. Median [IQR] BG and nutrition rates achieved were lower for STAR (118 [109 129] vs. 139 [117 160] mg/dL and 7.0 [4.7 8.2] vs. 9.8 [8.6 11.5] g/h), while higher insulin rates were administered in STAR (3.0 [2.0 4.0] vs. 2.5 [2.0 3.0] U/h). However, workload was increased under STAR (12 vs. 7 measurements per day), as expected from measurement interval difference between STAR (3-hourly) and the SP (4-hourly). Conclusion: This unique patient-specific risk-based dosing approach GC framework was successful in controlling all patients safely and effectively. These preliminary results are encouraging and show GC can be achieved safely and effectively at lower target bands. In turns, these improved GC outcomes could improve patient outcomes. [less ▲]

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See detailCorticosteroid therapy is associated with a decrease in mortality in a multicenter cohort of mechanically ventilated COVID-19 patients
LAMBERMONT, Bernard ULiege; ERNST, Marie ULiege; DEMARET, P et al

in Intensive Care Medicine Experimental (2020)

Retrospectively analyzing the data of a multicenter cohort, we observed that mortality of patients with SARS-CoV-2 pneumoniatreated with mechanical ventilation was as high as 45% and median survival time ... [more ▼]

Retrospectively analyzing the data of a multicenter cohort, we observed that mortality of patients with SARS-CoV-2 pneumoniatreated with mechanical ventilation was as high as 45% and median survival time was 82 days. In this series, the risk factors for mortality included age, renal and circulatory dysfunction, lymphopenia and the absence of corticosteroid use during the first week of mechanical ventilation. Corticosteroid therapy during the first week of mechanical ventilation was associated with a lower mortality (34% vs 48%) (p = 0,01). [less ▲]

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See detailLow incidence of thrombotic events in SARS-CoV-2 mechanically ventilated anticoagulated patients
Perot, Antoine ULiege; Misset, Benoît ULiege; MASSION, Paul ULiege et al

in Intensive Care Medicine Experimental (2020)

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See detailLa première vague de la COVID-19 aux Soins intensifs
MARCHETTA, Stella ULiege; LAMBERMONT, Bernard ULiege; MASSION, Paul ULiege et al

in Revue Médicale de Liège (2020)

In December 2019, in Wuhan, a new human infectious pathology was born, COVID-19, consisting above all in pneumoniae, induced by the coronavirus named SARS-CoV-2 because of the respiratory distress it ... [more ▼]

In December 2019, in Wuhan, a new human infectious pathology was born, COVID-19, consisting above all in pneumoniae, induced by the coronavirus named SARS-CoV-2 because of the respiratory distress it caused (SARS for severe acute respiratory syndrome, and CoV for Coronavirus). A real health and planetary crisis has appeared, much more substantial than that linked to SARS-CoV-1 in 2002-2004 and to MERS-CoV (Middle East Respiratory Syndrome Coronavirus) in 2012. In addition to respiratory damage that can be dramatic, this pathology is complicated by the frequency of cardiovascular, renal and coagulation diseases. Health care systems have had to adapt urgently, in the absence of hindsight from the patho- logy, and without effective therapeutic weapons. Through this review of the literature, we detail our local practices for the overall management of patients hospitalized in Intensive care. [less ▲]

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See detailSTAR-Liège: Modulating Insulin AND Nutrition Improves Glycaemic Control
Uyttendaele, Vincent ULiege; Knopp, Jennifer L.; PIROTTE, Marc ULiege et al

Poster (2020)

Introduction: Stress-induced hyperglycaemia is a common complication associated with higher morbidity and mortality in ICU patients. The Stochastic TARgeted (STAR) glycaemic control (GC) framework ... [more ▼]

Introduction: Stress-induced hyperglycaemia is a common complication associated with higher morbidity and mortality in ICU patients. The Stochastic TARgeted (STAR) glycaemic control (GC) framework provides consistent, safe, effective control in different ICUs and countries. It is a patient-specific, risk-based protocol controlling both insulin and nutrition dosing. This study analyses safety and efficacy of STAR at the University Hospital of Liège, Belgium, and assesses the impact of also modulating nutrition on GC outcomes. Methods: Patients are included after 2 blood glucose (BG) > 145 mg/dL. The study compares STAR (N=14; modulating insulin and nutrition) and STAR-IO (N=15; controlling insulin only, leaving nutrition at clinical discretion). STAR controls nutrition between 30-100% of goal feed if insulin alone cannot safely reduce BG. The target band is 80- 145 mg/dL for both arms. GC was stopped after 72h or if BG in target at insulin rate ≤2U/h for 6 hours. Performance is assessed by %BG in target and the median [IQR] BG, and safety by %BG below (<80 mg/dL) and above (>145 mg/dL) target. Ethics approval was granted by the University Hospital of Liège Ethics Committee. Results: Table 1 shows better performance for STAR (83% vs 78% BG in target), and better safety from hypoglycaemia (0.7% vs 1.5%) and hyperglycaemia (17% vs 21%). Median [IQR] BG are similar (STAR: 121 [110 135] mg/dL vs STAR-IO: 119 [106 137] mg/dL). Despite controlling nutrition, STAR provided higher median [IQR] nutrition than STAR-IO (98 [67 109] vs 93 [53 103] %Goal) and required lower workload (13.6 vs 15.5 assays per day). Conclusion: STAR outperforms STAR-IO. Both STAR and STAR-IO provide safe, effective control for all patients. GC safety and performance can be improved by patient-specific control of nutrition, in addition to insulin, for highly insulin resistant patients. [less ▲]

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See detailLetter to the Editor in response to “COVID-19: desperate times call for desperate measures
Chase, JG; Chiew, YS; LAMBERMONT, Bernard ULiege et al

in Critical Care (2020)

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See detailSafe doubling of ventilator capacity: A last resort proposal for last resorts
Chase, J. G.; Chiew, Y. S.; Lambermont, Bernard ULiege et al

in Critical Care (2020), 24(1),

[No abstract available]

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See detailRisk-based Dosing of Insulin and Nutrition Improves Glycaemic Control Outcomes
Uyttendaele, Vincent ULiege; Knopp, Jennifer L.; PIROTTE, Marc ULiege et al

Poster (2019, November)

Objective: Hyperglycaemia and insulin resistance are common in critically ill patients and associated with worsened outcomes. STAR (Stochastic TARgeted) glycaemic control (GC) has proven effective over ... [more ▼]

Objective: Hyperglycaemia and insulin resistance are common in critically ill patients and associated with worsened outcomes. STAR (Stochastic TARgeted) glycaemic control (GC) has proven effective over different units and clinical practices. Unlike many protocols, STAR also modulates nutrition with insulin, using a patient-specific risk-based dosing approach to provide greater flexibility in control. This study compares and assesses safety and efficacy of the ongoing STAR clinical trial results at the University Hospital of Liège, Belgium. Method: Two arms are compared: the first uses an insulin only version of STAR (STAR-IO), and the second the full insulin+nutrition version of STAR. The target band is 80-145mg/dL. Insulin is administered IV and nutrition is administered enterally. GC was stopped after 72h or if BG was stable at insulin rate ≤2U/h. Safety is assessed by %BG <80mg/dL below target and hyperglycaemia (%BG>180mg/dL). Performance is evaluated by %BG within target band and median BG. Clinical data from 11 patients on STAR-IO and 10 patients on STAR totalling 1100 hours of control is used. Ethics approval was granted by the University Hospital of Liège Ethics Committee. Results: STAR performance is statistically significantly better compared to STAR-IO (89% vs. 78% for %BG in target band, p<0.01 using Fisher Exact test). Median [IQR] BG is similar but tighter in STAR (118[109 129] vs. 120[107 138]mg/dL, p=0.19 using Wilcoxon rank sum test). STAR is also safer compared to STAR-IO with 0.7% vs. 1.4% for %BG<80 mg/dL and only 2.0% vs. 9.8% for %BG>180mg/dL. This outcome was achieved using less insulin and nutrition rates for STAR vs STAR-IO (3.0[2.0 4.0] U/h vs. 3.5[1.5 6]U/h and 7.0[4.7 8.2] vs. 8.1[4.9 9.2]g/h). Conclusions: Modulating nutrition in addition to insulin can significantly improve GC outcomes, especially by reducing nutrition rates for highly resistive patients. [less ▲]

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See detailLe syndrome de détresse respiratoire aiguë
Parzibut, Gilles ULiege; CANIVET, Jean-Luc ULiege; GUIOT, Julien ULiege et al

in Revue Médicale de Liège (2019), 74(10), 514-520

Since its first description in 1967, a lot of progress has been made in understanding the pathophysiology, diagnosis and management of acute respiratory distress syndrome (ARDS). This nosological entity ... [more ▼]

Since its first description in 1967, a lot of progress has been made in understanding the pathophysiology, diagnosis and management of acute respiratory distress syndrome (ARDS). This nosological entity is based on the appearance of a diffuse alveolar damage associating pulmonary epithelial barrier disruption with an alveolar filling, both responsible of profound hypoxemia and important morbi-mortality. Nowadays, ARDS remains a frequent syndrome, associated with various etiologies. Diagnosis is based on the occurrence of acute hypoxic respiratory failure not explained by cardiac insufficiency or volume overload, within 7 days after a recognized risk factor, and in the presence of bilateral pulmonary opacities not fully explained by effusions, atelectasis or nodules on the chest radiography. Survivors present an increased risk of developing cognitive decline, depression, post-traumatic stress, and typical ICU related side-effects such as polyneuropathy and sarcopenia. In this context and not withstanding significant recent progress in the field of mechanical ventilation and extra-corporeal respiratory assistance, early diagnosis remains essential to identify patients with ARDS in order to offer them the most appropriate therapy. [less ▲]

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See detailFeasibility and safety of extracorporeal CO2 removal to enhance protective ventilation in acute respiratory distress syndrome: the SUPERNOVA study.
Combes, Alain; Fanelli, Vito; Ranieri, Vito Marco et al

in Intensive Care Medicine (2019)

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See detailExtracorporeal CO2 removal and regional citrate anticoagulation in an experimental model of hypercapnic acidosis.
Morimont, Philippe ULiege; Habran, Simon; Desaive, Thomas ULiege et al

in Artificial Organs (2019)

Low flow extracorporeal veno-venous CO2 removal (ECCO2 R) therapy is used to remove CO2 while reducing ventilation intensity. However, the use of this technique is limited because efficiency of CO2 ... [more ▼]

Low flow extracorporeal veno-venous CO2 removal (ECCO2 R) therapy is used to remove CO2 while reducing ventilation intensity. However, the use of this technique is limited because efficiency of CO2 removal and potential beneficial effects on pulmonary hemodynamics are not precisely established. Moreover, this technique requires anticoagulation that may induce severe complications in critically ill patients. This study aimed at determining precisely efficiency of CO2 extraction and its effects on right ventricular (RV) afterload, and comparing regional anticoagulation with citrate to systemic heparin anticoagulation during ECCO2 R. ECCO2 R was highly efficient to normalize pH and PaCO2 and to reduce RV afterload resulting from hypercapnic acidosis. Regional anticoagulation with citrate solution was as effective as standard heparin anticoagulation but did not improve CO2 removal and lead to more hypocalcemia and hypotension. [less ▲]

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See detailLe syndrome de detresse respiratoire aigue.
Parzibut, G.; Canivet, J. L.; GUIOT, Julien ULiege et al

in Revue medicale de Liege (2019), 74(10), 514-520

Since its first description in 1967, a lot of progress has been made in understanding the pathophysiology, diagnosis and management of acute respiratory distress syndrome (ARDS). This nosological entity ... [more ▼]

Since its first description in 1967, a lot of progress has been made in understanding the pathophysiology, diagnosis and management of acute respiratory distress syndrome (ARDS). This nosological entity is based on the appearance of a diffuse alveolar damage associating pulmonary epithelial barrier disruption with an alveolar filling, both responsible of profound hypoxemia and important morbi-mortality. Nowadays, ARDS remains a frequent syndrome, associated with various etiologies. Diagnosis is based on the occurrence of acute hypoxic respiratory failure not explained by cardiac insufficiency or volume overload, within 7 days after a recognized risk factor, and in the presence of bilateral pulmonary opacities not fully explained by effusions, atelectasis or nodules on the chest radiography. Survivors present an increased risk of developing cognitive decline, depression, post-traumatic stress, and typical ICU related side-effects such as polyneuropathy and sarcopenia. In this context and not withstanding significant recent progress in the field of mechanical ventilation and extra-corporeal respiratory assistance, early diagnosis remains essential to identify patients with ARDS in order to offer them the most appropriate therapy. [less ▲]

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See detailSTAR-Liège Clinical Trial Interim Results: Safe and Effective Glycemic Control for All
Uyttendaele, Vincent ULiege; Knopp, Jennifer L.; PIROTTE, Marc ULiege et al

in Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society (2019)

While the benefits of glycemic control for critically ill patients are increasingly demonstrated, the ability to deliver safe, effective control to intermediate target ranges is widely debated due to the ... [more ▼]

While the benefits of glycemic control for critically ill patients are increasingly demonstrated, the ability to deliver safe, effective control to intermediate target ranges is widely debated due to the increased risk of hypoglycemia. This study analyzes interim clinical trial results of the fully computerized model-based Stochastic TARgeted (STAR) glycemic control framework at the University Hospital of Liège, Belgium. Patients with dysglycemia were randomly assigned to the full version of STAR, modulating both insulin and nutrition inputs, or STAR-IO, an insulin only version of STAR. Both arms target the normoglycemic 80-145 mg/dL (4.4-8.0 mmol/L) band. Results are further compared to retrospective data from 20 patients under the standard unit protocol targeting a higher 100-150 mg/dL (5.6-8.3 mmol/L) band. Much higher time in target band is provided under the full version of STAR, with similar safety and significantly lower incidence of mild hyperglycemia (blood glucose > 145 mg/dL or 8.0 mmol/L) and severe hyperglycemia (blood glucose > 180 mg/dL or 10.0 mmol/L). As a result, lower median blood glucose levels are safely and consistently achieved with lower glycemic variability, suggesting STAR’s potential to improve clinical outcomes. These interim results show the possibility to achieve safe, effective control for all patients using STAR, and suggest glycemic control to lower targets could be beneficial. [less ▲]

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See detailLeft ventricular ejection fraction depends on loading conditions.
MORIMONT, Philippe ULiege; LAMBERMONT, Bernard ULiege

in ASAIO Journal (2019)

Detailed reference viewed: 39 (7 ULiège)