References of "MORIMONT, Philippe"
     in
Bookmark and Share    
Full Text
Peer Reviewed
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

Detailed reference viewed: 34 (9 ULiège)
Full Text
Peer Reviewed
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 ▲]

Detailed reference viewed: 60 (8 ULiège)
Full Text
Peer Reviewed
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)

Detailed reference viewed: 32 (4 ULiège)
Full Text
Peer Reviewed
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]

Detailed reference viewed: 24 (1 ULiège)
Full Text
Peer Reviewed
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 ▲]

Detailed reference viewed: 49 (7 ULiège)
Full Text
Peer Reviewed
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 ▲]

Detailed reference viewed: 84 (9 ULiège)
Full Text
Peer Reviewed
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)

Detailed reference viewed: 742 (2 ULiège)
Full Text
Peer Reviewed
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 ▲]

Detailed reference viewed: 52 (9 ULiège)
Full Text
Peer Reviewed
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 ▲]

Detailed reference viewed: 43 (16 ULiège)
Full Text
Peer Reviewed
See detailLeft ventricular ejection fraction depends on loading conditions.
MORIMONT, Philippe ULiege; LAMBERMONT, Bernard ULiege

in ASAIO Journal (2019)

Detailed reference viewed: 33 (7 ULiège)
Full Text
Peer Reviewed
See detailInsulin-Only STAR: Liège Clinical Trial Interim Results on Safety and Efficacy
Uyttendaele, Vincent ULiege; Knopp, Jennifer L.; PIROTTE, Marc ULiege et al

Poster (2018, November)

Objective: Stress-induced hyperglycaemia and insulin resistance is common in critically ill patients and associated with worsened outcomes. STAR (Stochastic TARgeted) glycaemic control (GC) has proven ... [more ▼]

Objective: Stress-induced hyperglycaemia and insulin resistance is 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. However, this risk-based dosing approach uses both insulin and nutrition to control glycemia, where virtually all others use insulin only. This study uses STAR with insulin only and nutrition set clinically in the University Hospital of Liège, Belgium, to assess safety and efficacy in this use. Method: STAR-Liège is an insulin-only version of STAR targeting 80-145mg/dL. Patient are included if two successive BG measurements are >145mg/dL. Insulin is administered through IV catheter continuously and nutrition clinically set. GC was stopped after 72h or if BG was stable at insulin rate ≤2U/h. Safety is assessed by the %BG in severe (<40mg/dL), mild (<72mg/dL) hypoglycaemia, and >180mg/dL. Performance is evaluated by the %BG within target band and median BG. Clinical data from the first 11 patients is analysed, totalling 645 hours of control. Ethics approval was granted by the University Hospital of Liège Ethics Committee. Results: The insulin-only STAR-Liège protocol showed high performance, with median [IQR] BG of 122 [106, 147] mg/dL and 78% BG in target band. Mild hypoglycaemia occurred 1.6% of time, but there was no incidence of severe hypoglycaemia. Additionally, only 9.8% BG>180mg/dL, and administered insulin and nutrition was 4.0 [1.8, 4.6] U/h and 8.1 [4.9, 9.2] g/h. Conclusions: Insulin-only GC with the STAR-Liège protocol provided equally high control safety and quality for all patients. These results are encouraging, comparable to previous studies, and supporting STAR risk-based dosing approach as a robust solution across different ICU settings and usages, and support continuation of the clinical trial. [less ▲]

Detailed reference viewed: 51 (14 ULiège)
Full Text
Peer Reviewed
See detailMathematical modeling of extracorporeal CO2 removal therapy. A validation carried out on ten pigs
Habran, Simon ULiege; Desaive, Thomas ULiege; MORIMONT, Philippe ULiege et al

in Medical and Biological Engineering and Computing (2018), 56(3), 421-434

The extracorporeal CO2 removal device (ECCO2RD) is used in clinics to treat patients suffering from respiratory failures like acute respiratory distress syn- drome (ARDS) or chronic obstructive pulmonary ... [more ▼]

The extracorporeal CO2 removal device (ECCO2RD) is used in clinics to treat patients suffering from respiratory failures like acute respiratory distress syn- drome (ARDS) or chronic obstructive pulmonary disease (COPD). The aim of this device is to decarboxylate blood externally with low blood flow. A mathematical model is proposed to describe protective ventilation, ARDS, and an extracorporeal CO2 removal therapy (ECCO2RT). The sim- ulations are compared with experimental data carried out on ten pigs. The results show a good agreement between the mathematical simulations and the experimental data, which provides a nice validation of the model. This model is thus able to predict the decrease of PCO2 during ECCO2RT for different blood flows across the extracorporeal lung support. [less ▲]

Detailed reference viewed: 120 (38 ULiège)
Full Text
Peer Reviewed
See detailAfterload burden on the right ventricle is enhanced when ARDS is associated with hypercapnic acidosis.
MORIMONT, Philippe ULiege; Habran, Simon ULiege; Desaive, Thomas ULiege et al

in Annals of Intensive Care (2018, February 05), 8(1),

Detailed reference viewed: 68 (20 ULiège)
Full Text
Peer Reviewed
See detailCost-Effectivness of ECCO2R in the management of acute respiratory distress syndrome (ARDS)
Ethgen, Olivier ULiege; Makhija, Dilip; Harenski, Kai et al

in Critical Care Medicine (2018)

Detailed reference viewed: 29 (3 ULiège)
Full Text
Peer Reviewed
See detailPre-ejection period, the reason why the electrocardiogram Q-wave is an unreliable indicator of pulse wave initialization
Balmer, J.; Pretty, C.; Davidson, S. et al

in Physiological Measurement (2018), 39(9),

Objective: Pulse wave velocity measurements are an indicator of arterial stiffness and possible cardiovascular dysfunction. It is usually calculated by measuring the pulse transit time (PTT) over a known ... [more ▼]

Objective: Pulse wave velocity measurements are an indicator of arterial stiffness and possible cardiovascular dysfunction. It is usually calculated by measuring the pulse transit time (PTT) over a known distance through the arteries. In animal studies, reliable PTT measures can be obtained using two pressure catheters. However, such direct, invasive methods are undesirable in clinical settings. A less invasive alternative measure of PTT is pulse arrival time (PAT), the time between the Q-wave of an electrocardiogram (ECG) and the arrival of the foot of the beats pressure waveform at one pressure catheter. Since the Q-wave signifies the start of ventricular contraction, PAT includes the pre-ejection period (PEP), a time where no blood is ejected. Thus, inter- or intra- subject variation in PEP could result in poor correlation between pulse arrival time (PAT) and the desired pulse transit time (PTT). Approach: This study looks at the relationship between PAT and PTT, over a range of common critical care therapies and determines the effect of PEP on PAT as a possible surrogate of PTT in a critical care environment. The analysis uses data from five porcine experiments, where ECG, aortic arch and abdominal aortic pressure were measured simultaneously, over a range of induced hemodynamic conditions. Results: The resulting correlations of PAT verse PTT varied within pigs and across interventions (r 2 = 0.32-0.69), and across pigs (r 2 = 0.05-0.60). Variability was due to three main causes. First, the interventions themselves effect PEP and PTT differently, second, pig specific response to the interventions, and third, inter- and intra- pig variability in PEP, independent of PTT. Significance: The overall analysis shows PAT is an unreliable measure of PTT and a poor surrogate under clinical interventions common in a critical care setting, due to intra- and inter- subject variability in PEP. © 2018 Institute of Physics and Engineering in Medicine. [less ▲]

Detailed reference viewed: 25 (0 ULiège)
Full Text
Peer Reviewed
See detailPreliminary results from the STAR-Liège clinical trial: Virtual trials, safety, performance, and compliance analysis
Uyttendaele, Vincent ULiege; Knopp, Jennifer L.; PIROTTE, Marc ULiege et al

in IFAC-PapersOnLine (2018)

Glycaemic control has been shown to improve outcome in critically ill patients, but hard to achieve in a safe and effective manner. This paper presents the preliminary results of 8 patients controlled at ... [more ▼]

Glycaemic control has been shown to improve outcome in critically ill patients, but hard to achieve in a safe and effective manner. This paper presents the preliminary results of 8 patients controlled at the University Hospital of Liège under STAR-Liège, an insulin-only version of the model-based STAR glycaemic controller framework. Clinical data is compared with virtual trial simulations of the glycaemic control outcomes for the STAR-Liège protocol, and with the standard of care protocol of this intensive care unit, to assess safety, performance, and compliance of the new protocol. Results show 78% of clinical blood glucose measurements in target band. Only 3% of blood glucose measurements were below 4.4 mmol/L (79 mg/dL), with only 1% mild hypoglycaemia and no severe hypoglycaemia. These results are similar to simulation of the protocol, but slightly higher workload is observed clinically due to nursing choice. Compared to standard protocol virtual trial simulations, STAR-Liège achieved tighter and less variable control with similar safety, and less percentage time in higher blood glucose levels. Clinically, 14% of insulin intervention were increased or decreased from recommendation with median [IQR] change of 1 [1, 2] or -2 [-3, -2] U/hr respectively. Clinical and simulation results show STAR-Liège better controls glycaemia to lower ranges compared to the standard protocol, while ensuring safety. Lower time in higher blood glucose ranges potentially improves patient outcomes. Compliance analysis shows potential nurse fears in protocol changes and different insulin dosing. These results are encouraging for the continuation of the clinical trial realised in this medical intensive care unit and its extension to insulin and nutrition control. [less ▲]

Detailed reference viewed: 48 (17 ULiège)
Full Text
Peer Reviewed
See detailA mathematical model of respiration under protective ventilation and extracorporeal CO2 removal therapy
Habran, Simon ULiege; Desaive, Thomas ULiege; MORIMONT, Philippe ULiege et al

Conference (2017, September 27)

The aim of the present study is to build a mathematical model of the respiratory system connected to an extracorporeal CO2 removal device (ECCO2RD) to optimize the gas exchanges efficiency. The model must ... [more ▼]

The aim of the present study is to build a mathematical model of the respiratory system connected to an extracorporeal CO2 removal device (ECCO2RD) to optimize the gas exchanges efficiency. The model must be simple enough to provide rapid solutions and to estimate specific parameters from available clinical data. But it also must be complex enough to be able to simulate the respiratory system when protective ventilation is used and when this system is assisted by an ECCO2RD. [less ▲]

Detailed reference viewed: 87 (28 ULiège)