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Pierre Defrance

Bio: Pierre Defrance is an academic researcher from Université libre de Bruxelles. The author has contributed to research in topics: Renal function & Epinephrine. The author has an hindex of 3, co-authored 4 publications receiving 1279 citations.

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Journal ArticleDOI
TL;DR: Although there was no significant difference in the rate of death between patients with shock who were treated with dopamine as the first-line vasopressor agent and those who were treating with norepinephrine, the use of dopamine was associated with a greater number of adverse events.
Abstract: BACKGROUND Both dopamine and norepinephrine are recommended as first-line vasopressor agents in the treatment of shock. There is a continuing controversy about whether one agent is superior to the other. METHODS In this multicenter, randomized trial, we assigned patients with shock to receive either dopamine or norepinephrine as first-line vasopressor therapy to restore and maintain blood pressure. When blood pressure could not be maintained with a dose of 20 μg per kilogram of body weight per minute for dopamine or a dose of 0.19 μg per kilogram per minute for norepinephrine, open-label norepinephrine, epinephrine, or vasopressin could be added. The primary outcome was the rate of death at 28 days after randomization; secondary end points included the number of days without need for organ support and the occurrence of adverse events. RESULTS The trial included 1679 patients, of whom 858 were assigned to dopamine and 821 to norepinephrine. The baseline characteristics of the groups were similar. There was no significant between-group difference in the rate of death at 28 days (52.5% in the dopamine group and 48.5% in the norepinephrine group; odds ratio with dopamine, 1.17; 95% confidence interval, 0.97 to 1.42; P = 0.10). However, there were more arrhythmic events among the patients treated with dopamine than among those treated with norepinephrine (207 events [24.1%] vs. 102 events [12.4%], P<0.001). A subgroup analysis showed that dopamine, as compared with norepinephrine, was associated with an increased rate of death at 28 days among the 280 patients with cardiogenic shock but not among the 1044 patients with septic shock or the 263 with hypovolemic shock (P = 0.03 for cardiogenic shock, P = 0.19 for septic shock, and P = 0.84 for hypovolemic shock, in Kaplan–Meier analyses). CONCLUSIONS Although there was no significant difference in the rate of death between patients with shock who were treated with dopamine as the first-line vasopressor agent and those who were treated with norepinephrine, the use of dopamine was associated with a greater number of adverse events. (ClinicalTrials.gov number, NCT00314704.)

1,431 citations

Journal ArticleDOI
TL;DR: Urea administration appears useful for the treatment of SIADH-associated hyponatremia in critically ill patients, and prospective randomized controlled studies are needed to confirm these results.
Abstract: Background: Hyponatremia occurring as a result of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a common and potentially lethal complication in critically

38 citations

Journal ArticleDOI
TL;DR: The predictive value of RIFLE urine output criteria for the development of CA-AKI based on creatinine concentrations was low, which limits its use for assessing the effects of therapeutic interventions on the development and progression of AKI.
Abstract: To investigate the predictive value of decreased urine output based on the Risk of renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function and End-stage renal disease (RIFLE) classification on contrast- induced acute kidney injury (CA-AKI) in intensive care (ICU) patients.

8 citations

Journal ArticleDOI
TL;DR: Three cases of severe hyperkalemia induced by prophylactic doses of enoxaparin are reported in intensive care unit (ICU) patients for prevention of thrombosis, with few adverse effects.
Abstract: Dear Editor, Low-molecular-weight heparin (LMWH) is extensively used in intensive care unit (ICU) patients for prevention of thrombosis, with few adverse effects [1]. We report three cases of severe hyperkalemia induced by prophylactic doses of enoxaparin. A 71-year-old diabetic man was admitted for sepsis, with creatinine and serum potassium concentrations of 1.5 mg/dL and 2.0 mEq/L. Potassium increased to 4.7 mEq/L with 60 mEq/day supplement. On day 4, potassium supplement was stopped and enoxaparin started [40 mg subcutaneously (SC) once daily (o.d.)]. By day 6, potassium had increased to 6.1 mEq/L and was resistant to insulin/dextrose and sodium polystyrene sulfonate (SPS) treatments. Enoxaparin was discontinued, and potassium decreased in 4 days. A few days later, enoxaparin (20 mg o.d.) was reintroduced and potassium increased to 5.2 mEq/L. The patient was treated with SPS and discharged without thrombosis prophylaxis (Fig. 1a). A 63-year-old diabetic woman was admitted with cardiogenic shock. Creatinine was 0.7 mg/dL. Enoxaparin 20 mg o.d. was started and increased to 40 mg o.d. after 4 days. Serum potassium increased to 6.1 mEq/L within 3 days. The hyperkalemia was resistant to SPS treatment, and enoxaparin was withdrawn, following which there was a decrease in the potassium level. A few days later, enoxaparin was reintroduced and potassium increased again to 5.3 mEq/L rapidly. Enoxaparin was switched to fondaparinux (2.5 mg o.d.), and the potassium returned to normal values (Fig. 1b). A 71-year-old woman, treated for arterial hypertension, was admitted for spinal cord injury. Her creatinine concentration was 0.4 mg/dL. Five days after surgery, enoxaparin (40 mg o.d.) was started. Potassium rapidly increased, needing treatment with SPS. Enoxaparin was switched to fondaparinux (2.5 mg o.d.), resulting in a decrease in potassium to 4.6 mEq/L. A few days later,

3 citations


Cited by
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Journal ArticleDOI
TL;DR: Authors/Task Force Members: Piotr Ponikowski* (Chairperson) (Poland), Adriaan A. Voors* (Co-Chair person) (The Netherlands), Stefan D. Anker (Germany), Héctor Bueno (Spain), John G. F. Cleland (UK), Andrew J. S. Coats (UK)

13,400 citations

Journal ArticleDOI
TL;DR: An update to the “Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock,” last published in 2008 is provided.
Abstract: Objective:To provide an update to the “Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock,” last published in 2008.Design:A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at ke

9,137 citations

Journal ArticleDOI
TL;DR: The once-in-a-lifetime treatment with Abciximab Intracoronary for acute coronary syndrome and a second dose intravenously for atrial fibrillation is recommended for adults with high blood pressure.
Abstract: ACE : angiotensin-converting enzyme ACS : acute coronary syndrome ADP : adenosine diphosphate AF : atrial fibrillation AMI : acute myocardial infarction AV : atrioventricular AIDA-4 : Abciximab Intracoronary vs. intravenously Drug Application APACHE II : Acute Physiology Aand Chronic

7,519 citations

Journal ArticleDOI
TL;DR: ACCF/AHAIAI: angiotensin-converting enzyme inhibitor as discussed by the authors, angio-catabolizing enzyme inhibitor inhibitor inhibitor (ACS inhibitor) is a drug that is used to prevent atrial fibrillation.
Abstract: ACC/AHA : American College of Cardiology/American Heart Association ACCF/AHA : American College of Cardiology Foundation/American Heart Association ACE : angiotensin-converting enzyme ACEI : angiotensin-converting enzyme inhibitor ACS : acute coronary syndrome AF : atrial fibrillation

7,489 citations

Journal ArticleDOI
TL;DR: Authors/Task Force Members: Piotr Ponikowski* (Chairperson) (Poland), Adriaan A. Voors* (Co-Chair person) (The Netherlands), Stefan D. Anker (Germany), Héctor Bueno (Spain), John G. F. Cleland (UK), Andrew J. S. Coats (UK)
Abstract: ACC/AHA : American College of Cardiology/American Heart Association ACCF/AHA : American College of Cardiology Foundation/American Heart Association ACE : angiotensin-converting enzyme ACEI : angiotensin-converting enzyme inhibitor ACS : acute coronary syndrome AF : atrial fibrillation

6,757 citations