Publications of Marie-Bernard HUBERT
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See detailLow Cardiac Output Syndrome After Adult Cardiac Surgery: Predictive Value of Peak Systolic Global Longitudinal Strain.
AMABILI, Philippe ULiege; Benbouchta, Sabeha ULiege; ROEDIGER, Laurence ULiege et al

in Anesthesia and Analgesia (2018)

BACKGROUND: Peak systolic global longitudinal strain (GLS) is increasingly used to quantify left ventricular systolic function. The primary objective of this study was to assess whether GLS obtained ... [more ▼]

BACKGROUND: Peak systolic global longitudinal strain (GLS) is increasingly used to quantify left ventricular systolic function. The primary objective of this study was to assess whether GLS obtained during intraoperative transesophageal echocardiogram, performed before cardiopulmonary bypass, improves the prediction of postoperative low cardiac output syndrome (LCOS) after adult cardiac surgery. METHODS: GLS from 275 patients undergoing on-pump cardiac surgery was calculated retrospectively using two-dimensional- speckle tracking echocardiography (aCMQ module from Qlab software version 10.5, Philips Medical, Brussels, Belgium). LCOS was defined as the need for inotropic or mechanical circulatory support for >24 hours postoperatively. Patient and procedure characteristics associated with LCOS at the univariable level (P </= .05) were entered into a forward stepwise logistic regression to create a first predictive model. A second model was created by adding GLS. The 2 models were compared using the likelihood-ratio test, the area under the receiver operating characteristic (ROC) curve, and the integrated discrimination index. The optimal cutoff value of GLS associated with LCOS was determined by maximizing the Youden index of the ROC curve. Secondary outcomes included time until complete weaning from inotropes, discharge from the intensive care unit and from the hospital, and 30-day mortality. RESULTS: GLS was significantly associated with LCOS (P < .001) at the univariable level. Predictors of LCOS retained in the first model were cardiopulmonary bypass duration, decreased left ventricular ejection fraction, mitral valve surgery, and New York Heart Association functional class III or IV. Adding the GLS value improved the prediction of LCOS (P = .02). However, the area under the ROC curve did not differ between the 2 models (0.83; 95% confidence interval [CI], 0.77-0.99 vs 0.84; 95% CI, 0.79-0.90; P = .15). The integrated discrimination index associated with addition of GLS was 0.02 (P = .046), meaning that the difference in predicted risk between patients with and without LCOS increased by 2% after adding GLS. A GLS cutoff value of -17% (95% CI, -18.8% to -15.3%) was found to best identify LCOS. After adjusting for covariates included in model 1, a lower GLS value was significantly associated with a lower cumulative probability of weaning from inotropes postoperatively (hazard ratio, 0.90; 95% CI, 0.82-0.97; P = .01). No association was found between GLS and other secondary outcome measures. CONCLUSIONS: GLS is an independent predictor of LCOS after on-pump cardiac surgery. Its incremental value over other established risk factors for postoperative LCOS is, however, limited. [less ▲]

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See detailEffect of hydroxy ethyl starch (HES) 130/0.4 on renal function and mortality one year after adult cardiac surgery : A single center retrospective study
AMABILI, Philippe ULiege; Servais, E.; Senard, Marc ULiege et al

in Acta Anaesthesiologica Belgica (2017), 68(2), 73-79

Hydroxyethyl starch (HES) adversely affect short-term survival and renal function of intensive care unit and possibly of surgical patients. We retrospectively investigated whether using HES as a pump ... [more ▼]

Hydroxyethyl starch (HES) adversely affect short-term survival and renal function of intensive care unit and possibly of surgical patients. We retrospectively investigated whether using HES as a pump prime and for intraoperative fluid therapy is associated with mortality and end-stage renal failure one year after adult cardiac surgery. Multivariable logistic regression was used to adjust for imbalanced characteristics between the two study groups. The primary outcome, a composite of end-stage renal failure or mortality during the first postoperative year was observed in 9.7% of patients who received HES and in 6.2% of patients treated with crystalloids only (Adjusted OR 1.05; 95%CI, 0.5-2; P = 0.9). These results suggest that using HES or balanced crystalloids as a pump prime and for intraoperative fluid therapy results in similar one-year outcomes but must be considered as preliminary given the limited statistical power of the study. [less ▲]

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See detailHydroxyethyl Starch 130/0.4 and the Risk of Acute Kidney Injury After Cardiopulmonary Bypass: A Single-Center Retrospective Study.
LAGNY, Marc-Gilbert ULiege; ROEDIGER, Laurence ULiege; KOCH, Jean-Noël ULiege et al

in Journal of Cardiothoracic and Vascular Anesthesia (2015)

Hydroxyethyl Starches (HES) have been shown to increase the risk of acute kidney injury (AKI) in intensive care unit patients suffering sepsis. Whether this risk also applies to patients undergoing ... [more ▼]

Hydroxyethyl Starches (HES) have been shown to increase the risk of acute kidney injury (AKI) in intensive care unit patients suffering sepsis. Whether this risk also applies to patients undergoing elective surgery remains unclear. We investigated whether HES is associated with acute kidney injury after on-pump cardiac surgery. Materials and Methods: Balanced HES 130/0.4 (Volulyte®, Fresenius Kabi AG, Bad Homburg, Germany) was used as a pump prime and for intraoperative fluid therapy until July 2013 and has been entirely replaced by a balanced crystalloid solution (Plasmalyte®, Baxter, Lessines, Belgium) from August 2013. Data from 697 adult patients undergoing cardiac surgery between April 2013 and June 2014 were reviewed. HES patients were propensity-matched on previously published risk factors for AKI after cardiac surgery to patients treated with crystalloids. Postoperative AKI was defined as the primary outcome and assessed using the Acute Kidney Injury Network classification. A conditional logistic regression was used to investigate the association between the use of HES and postoperative AKI. Secondary outcomes included renal function at postoperative day 7, 30-day mortality, lengths of ICU and hospital stays and the incidence of postoperative respiratory complications. Results and Discussion: One hundred and thirty HES patients were successfully matched with 130 crystalloids patients. HES was significantly associated with postoperative AKI (odds ratio=2.4; 95 % CI= 1.2-4.8; P=0.02). No significant association was found between HES and any of the secondary outcomes. Conclusion: This study suggests that using balanced HES 130/0.4 as a pump prime and for intraoperative fluid therapy in adult patients undergoing on-pump cardiac surgery is associated with a higher incidence of AKI during the early postoperative period. [less ▲]

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See detailThe effect of intraoperative 6% balanced hydroxyethyl starch (130/0.4) during cardiac surgery on transfusion requirements.
HANS, Grégory ULiege; LEDOUX, Didier ULiege; ROEDIGER, Laurence ULiege et al

in Journal of Cardiothoracic and Vascular Anesthesia (2015), 29(2), 328-32

OBJECTIVES: To compare transfusion requirements in adult cardiac surgery patients when balanced hydroxyethyl starches (HES) (130/0.4) or balanced crystalloids is used for pump prime and intraoperative ... [more ▼]

OBJECTIVES: To compare transfusion requirements in adult cardiac surgery patients when balanced hydroxyethyl starches (HES) (130/0.4) or balanced crystalloids is used for pump prime and intraoperative fluid therapy. DESIGN: Data were obtained retrospectively from medical records and perfusion charts. Matching based on propensity scores was used to adjust for potential confounders. SETTING: A university hospital. PARTICIPANTS: Adult patients undergoing cardiac surgery with the use of cardiopulmonary bypass. INTERVENTIONS: Allocation to one of the study groups according to whether balanced HES or balanced crystalloids was used for pump prime and intraoperative fluid therapy. MEASUREMENTS AND MAIN RESULTS: 240 propensity-matched patients were retained for final analyses. Forty-eight patients (40%) of the colloid group and 28 patients (23.3%) of the crystalloid group received blood products, with an odd ratio (95% CI) of 2.1(1.2-3.8 (P=0.009). After bypass HES patients had lower hemoglobin levels (8.4 [1.3] gr/dL vs 9.6 [2] gr/dL; P<0.001) and a higher cumulative chest drain output after 3 hours (180 [210] mL vs 140 [100] mL, P<0.001]. Heparinase thromboelastogram (TEG(R)) showed longer K times (2.5[1.1] vs 1.6[0.8], P<0.001) and lower maximal amplitudes (55.1[12.5] vs 63.4[9.8], P=0.008). CONCLUSIONS: HES patients required more transfusions, owing to greater hemodilution, HES-induced clotting disturbances, and bleeding. [less ▲]

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See detailEffect of celecoxib combined with thoracic epidural analgesia on pain after thoracotomy
Senard, Marc ULiege; Deflandre, Eric; Ledoux, Didier ULiege et al

in British Journal of Anaesthesia (2010), 105(2), 196-200

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See detailAnesthésie locorégionale et anti-agrégants plaquettaires: le jeu en vaut-il la chandelle?
Senard, Marc ULiege; Roediger, Laurence ULiege; Hubert, Marie-Bernard ULiege et al

in Praticien en Anesthésie Réanimation (2010), 14

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See detailCerebral subarachnoid blood migration consecutive to a lumbar haematoma after spinal anaesthesia
Goujon-Dubois, Julie; Hans, Grégory ULiege; Senard, Marc ULiege et al

in Acta Anaesthesiologica Belgica (2008), 59(3), 223

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See detailActualites en anesthésie-réanimation en chirurgie cardiaque adulte
Roediger, Laurence ULiege; Larbuisson, Robert ULiege; Senard, Marc ULiege et al

in Revue Médicale de Liège (2004), 59(1), 35-45

Anesthetic techniques and treatment of cardiac surgery patients have considerably evolved over the past twenty years. The demand for cardiac surgical procedures is increasing. This demand coincides with a ... [more ▼]

Anesthetic techniques and treatment of cardiac surgery patients have considerably evolved over the past twenty years. The demand for cardiac surgical procedures is increasing. This demand coincides with a change in the profile of patients presenting for surgery, requiring modification in perioperative management strategies. Several new anesthetics, related drugs, and technologies have become available in recent years that inevitably have made new approaches with patient management possible. In parallel to these new developments, there have appeared real opportunities to apply novel physiologic and pharmacologic concepts that may redefine our clinical practice. Fast-tracking, which emphasizes the major role of anesthetic management in postoperative outcome, is one such line of investigation. Fast-tracking was first introduced in an attempt to decrease the time to tracheal extubation and reduce expensive time in intensive care unit areas. Large doses of opioids have been clearly identified as a factor in delaying weaning from mechanical ventilatory support after cardiac surgery. Thus, early investigations emphasized the importance of limiting the dose of potent opioid analgesics during the intraoperative period to achieve early recovery. Supplementation with hypnotic drugs allows reduction of the opioid dose, enabling earlier extubation without compromising hemodynamic stability. Fast track cardiac anesthesia (FTCA) is becoming an accepted practice for perioperative management of cardiac surgical patients. FTCA is a key component to successful conduction of fast-track cardiac surgery. Also, analgesia management in cardiac surgery is becoming more important with the establishment of minimally invasive direct coronary artery bypass surgery and fast track management of conventional cardiac surgery patients. [less ▲]

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See detailPeripheral vascular surgery: Update on the perioperative non-surgical management for high cardiac risk patients
Stammet, P.; Senard, Marc ULiege; Roediger, Laurence ULiege et al

in Acta Chirurgica Belgica (2003), 103(3), 248-254

This review of the recent literature regarding perioperative management in peripheral vascular surgery emphasizes some of the important features for the 2003 state-of-the-art on non surgical perioperative ... [more ▼]

This review of the recent literature regarding perioperative management in peripheral vascular surgery emphasizes some of the important features for the 2003 state-of-the-art on non surgical perioperative care for these high cardiac risk patients. The most adapted preoperative cardiac evaluation for each patient is guided by its individual risk factors and clinical history. Perioperative medication should nowadays consist of pre- and postoperative beta-blockers and acetyl salicylic acid, both reducing cardiac morbidity and mortality. Neuraxial locoregional anaesthesia techniques are reasonable alternatives to general anaesthesia because of their potential advantages, by reducing postoperative inflammatory response and reducing procoagulating activity, and increasing peripheral vascular graft patency, but the individual benefit/risk balance has always to be evaluated for patients submitted to aggressive antithrombotic therapy. During the postoperative course, early detection and treatment of postoperative myocardial ischemia or infarction by ST wave changes and/or cardiac enzyme control has to be considered. [less ▲]

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See detailHemodynamic changes and catecholamine release during laparoscopic adrenalectomy for pheochromocytoma.
Joris, Jean ULiege; Hamoir, Etienne ULiege; Hartstein, Gary ULiege et al

in Anesthesia and Analgesia (1999), 88(1), 16-21

We investigated hemodynamics and plasma catecholamine concentrations in eight consecutive patients undergoing laparoscopic adrenalectomy for suspected pheochromocytoma. The same anesthesia protocol was ... [more ▼]

We investigated hemodynamics and plasma catecholamine concentrations in eight consecutive patients undergoing laparoscopic adrenalectomy for suspected pheochromocytoma. The same anesthesia protocol was used in all patients: a continuous infusion of sufentanil 0.5 microg x kg(-1) x h(-1) and isoflurane 0.4% (end-tidal) in 50% N2O/O2. Systolic arterial pressure was maintained between 120 and 160 mm Hg by adjusting an infusion of nicardipine, a calcium-channel blocker, while tachycardia (>100 bpm) was treated by 1-mg boluses of atenolol. Hemodynamics (thermodilution technique) and plasma catecholamine concentrations were measured before surgery, after the induction of anesthesia, after turning the patient to the lateral position, during pneumoperitoneum, during tumor manipulation, after adrenalectomy, and at the end of surgery. Two events resulted in significant catecholamine release: creation of the pneumoperitoneum and adrenal gland manipulation. As a consequence, a twofold increase in cardiac output was recorded. Adjustments of nicardipine infusion (2-6 microg x kg(-1) x min(-1)) minimized changes in mean arterial pressure. Beta-adrenergic blockade was necessary in six patients. In conclusion, laparoscopic adrenalectomy for pheochromocytoma results in marked catecholamine release during pneumoperitoneum and tumor manipulation. Titration of a nicardipine infusion allowed easy and quick control of the hemodynamic aberrancies related to these processes. IMPLICATIONS: Pneumoperitoneum during laparoscopy, now used for adrenalectomy, may complicate anesthetic management of patients with pheochromocytoma. In this study, laparoscopic adrenalectomy was associated with catecholamine release during the creation of pneumoperitoneum and tumor manipulation. Adjustments of a nicardipine infusion readily attenuated the subsequent hemodynamic aberrancies. [less ▲]

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