Gender differences in professional social networks use among critical care researchers.

BACKGROUND: Recent studies highlight that female anaesthesiology researchers have lower visibility on professional social networks (PSNs) than male researchers. OBJECTIVE: The objective of this work was to compare the use of PSNs between women and men in critical care research. METHODS: We included the first/last authors (FAs/LAs) among the most frequently cited articles in 2018 and 2019 in three critical care journals (Intensive Care Medicine, Critical Care Medicine, and Critical Care). We compared the use of three PSNs-Twitter, ResearchGate, and LinkedIn-between women and men in the FA/LA positions. RESULTS: We analysed 494 articles, which allowed us to include 426 FAs and 383 LAs. The use of a PSN was similar between women and men (Twitter: 35 vs. 31% FA p = 0.76, 38 vs. 31% LA p = 0.24; ResearchGate: 60 vs. 70% FA p = 0.06, 67 vs. 66% LA p = 0.95; LinkedIn: 54 vs. 56% FA p = 0.25, 68 vs. 64% LA p = 0.58; respectively). On ResearchGate, women had a lower reputation score (FA group 26.4 [19.5-31.5] vs. 34.8 [27.4-41.6], p < 0.01; LA group 38.5 [30.9-43.7] vs. 42.3 [37.6-46.4], p < 0.01) and fewer followers (FA group 28.5 [19-45] vs. 68.5 [72,5-657] p < 0.01; LA group 96.5 [43,8-258] vs. 178 [76.3-313.5] p = 0.02). Female researchers were FAs in 30% of the articles and LAs in 16%. CONCLUSION: In the field of critical care, the visibility of female researchers on the social networks dedicated to scientific research is lower than that of male researchers.

Soluble TREM-1 plasma levels are associated with acute kidney injury, acute atrial fibrillation and prolonged ICU stay after cardiac surgery- a proof-concept study.

Background: Cardiopulmonary bypass (CPB) during cardiac surgery leads to deleterious systemic inflammation. We hypothesized that TREM-1, a myeloid receptor shed after activation, drives systemic inflammation during CPB. Methods: Prospective observational bi-centric study. Blood analysis (flow cytometry and ELISA) before and at H2 and H24 after CPB. Inclusion of adult patients who underwent elective cardiac surgery with CPB. Results: TREM-1 expression on neutrophils decreased between H0 and H2 while soluble (s)TREM-1 plasma levels increased. sTREM-1 levels increased at H2 and at H24 (p < 0.001). IL-6, IL-8, G-CSF and TNF-α, but not IL-1ß, significantly increased at H2 compared to H0 (p < 0.001), but dropped at H24. Principal component analysis showed a close relationship between sTREM-1 and IL-8. Three patterns of patients were identified: Profile 1 with high baseline sTREM-1 levels and high increase and profile 2/3 with low/moderate baseline sTREM-1 levels and no/moderate increase overtime. Profile 1 patients developed more severe organ failure after CPB, with higher norepinephrine dose, higher SOFA score and more frequently acute kidney injury at both H24 and H48. Acute atrial fibrillation was also more frequent in profile 1 patients at H24 (80% vs. 19.4%, p = 0.001). After adjustment on age and duration of CPB, H0, H2 and H24 sTREM-1 levels remained associated with prolonged ICU and hospital length of stay. Conclusions: Baseline sTREM-1 levels as well as early kinetics after cardiac surgery identified patients at high risk of post-operative complications and prolonged length of stay.

Ventriculo-arterial (un)coupling in septic shock: Impact of current and upcoming hemodynamic drugs.

Sepsis is an archetype of distributive shock and combines different levels of alterations in preload, afterload, and often cardiac contractility. The use of hemodynamic drugs has evolved over the past few years, along with the invasive and non-invasive tools used to measure these components in real time. However, none of them is impeccable, which is why the mortality of septic shock remains too high. The concept of ventriculo-arterial coupling (VAC) allows for the integration of these three fundamental macroscopic hemodynamic components. In this mini review, we discuss the knowledge, tools, and limitations of VAC measurement, along with the evidence supporting ventriculo-arterial uncoupling in septic shock. Finally, the impact of recommended hemodynamic drugs and molecules on VAC is detailed.

Point-of-Care Viscoelastic Hemostatic Assays in Cardiac Surgery Patients: Comparison of Thromboelastography 6S, Thromboelastometry Sigma, and Quantra.

OBJECTIVES: Viscoelastic tests allow a reduction in blood product transfusion. Three modern devices are currently available (rotational thromboelastometry [ROTEM] sigma, thromboelastography [TEG] 6S, and Quantra). No study has compared the performances of these 3 devices simultaneously. DESIGN: An observational, nonrandomized cohort study. SETTING: A single-center of cardiac surgery in a university hospital. PARTICIPANTS: A total of 30 consecutive measurements from at least 10 adult patients presenting significant bleeding in the intensive care unit after cardiac surgery INTERVENTION: Viscoelastic tests using ROTEM sigma, TEG 6S, and Quantra were performed concomitantly with conventional coagulation measurements MEASUREMENTS AND MAIN RESULTS: The authors included 16 patients with 31 blood samples. After the exclusion of missing values, 27 samples were analyzed. Correlation with platelet count was as follows: ROTEM, r = 0.84 [0.66-0.93], p < 0.0001; Quantra, r = 0.83 [0.64-0.92], p < 0.0001; TEG 6S, r = 0.64 [0.29-0.83], p = 0.001. Correlation with fibrinogen (Clauss assay) was as follows: ROTEM, r = 0.85 [0.68-0.93], p < 0.0001; Quantra, r = 0.88 [0.74-0.95], p < 0.0001; TEG 6S, r = 0.79 [0.55-0.91], p < 0.0001. No difference was observed for the detection of residual circulating heparin (anti-Xa activity >0.1), with 87% of correct identification for Quantra and 80% for both ROTEM and TEG 6S (p = 0.3). Time to first results after the beginning of the test was shorter for Quantra than ROTEM and TEG 6S (136 [126-152] seconds v 205 [176-221] seconds, p = 0.003 and v 450 [372-516] seconds, p < 0.0001 respectively). CONCLUSION: ROTEM sigma, TEG 6S, and Quantra performed similarly for exploring platelet count or residual circulating heparin. Thromboelastography 6S presented a weaker correlation with fibrinogen Clauss.

Women's visibility at European Society for Clinical Nutrition and Metabolism congresses from 2011 to 2019: Is the floor yours?

Purpose: Participating in international conferences is an essential way to promote scholarly work. We aimed to assess the trend of women's visibility at the European Society for Clinical Nutrition and Metabolism (ESPEN) congress by describing the evolution of the proportion of women speakers between 2011 and 2019. Materials and methods: This is a retrospective study including public data obtained from the 2011, 2015, and 2019 ESPEN congresses. The primary endpoint was the percentage of women speakers in major oral sessions (oral communications and specific conferences including prestigious lectures). The secondary endpoints were the proportion of women in other high-visibility positions (moderators, industry-led symposia interventions) and countries of origin. Results: The proportion of women speakers in oral communications remained stable between 2011 and 2019 [43% (43/100) vs. 41% (46/111), respectively; p = 0.89]. The proportion of women moderators in oral communications sessions significantly increased between 2011 and 2019 [13% (6/45) vs. 41% (19/46), respectively; p = 0.004]. The percentage of women speakers and moderators in industry-led symposia significantly increased between 2011 and 2019 [11% (2/18) vs. 41% (11/27), p = 0.05; 0% (0/6) vs. 60% (6/10), p = 0.03, respectively]. The percentage of women moderators in educational sessions also remained stable during the period with a marked under-representation of women in 2015. During all three congresses, women from the host countries were over-represented as moderators compared to women from other countries. Conclusion: The percentage of women speakers in oral communications remained stable in the last 8 years at ESPEN congresses, although women's representation in other high-visibility positions has increased. As men remained over-represented, women should be more encouraged to promote their academic work in the field of clinical nutrition, particularly during this international congress.

Effect of mechanical ventilation during cardiopulmonary bypass on end-expiratory lung volume in the perioperative period of cardiac surgery: an observational study.

BACKGROUND: Many studies explored the impact of ventilation during cardiopulmonary bypass (CPB) period with conflicting results. Functional residual capacity or End Expiratory Lung Volume (EELV) may be disturbed after cardiac surgery but the specific effects of CPB have not been studied. Our objective was to compare the effect of two ventilation strategies during CPB on EELV. METHODS: Observational single center study in a tertiary teaching hospital. Adult patients undergoing on-pump cardiac surgery by sternotomy were included. Maintenance of ventilation during CPB was left to the discretion of the medical team, with division between "ventilated" and "non-ventilated" groups afterwards. Iterative intra and postoperative measurements of EELV were carried out by nitrogen washin-washout technique. Main endpoint was EELV at the end of surgery. Secondary endpoints were EELV one hour after ICU admission, PaO2/FiO2 ratio, driving pressure, duration of mechanical ventilation and post-operative pulmonary complications. RESULTS: Forty consecutive patients were included, 20 in each group. EELV was not significantly different between the ventilated versus non-ventilated groups at the end of surgery (1796 ± 586 mL vs. 1844 ± 524 mL, p = 1) and one hour after ICU admission (2095 ± 562 vs. 2045 ± 476 mL, p = 1). No significant difference between the two groups was observed on PaO2/FiO2 ratio (end of surgery: 339 ± 149 vs. 304 ± 131, p = 0.8; one hour after ICU: 324 ± 115 vs. 329 ± 124, p = 1), driving pressure (end of surgery: 7 ± 1 vs. 8 ± 1 cmH2O, p = 0.3; one hour after ICU: 9 ± 3 vs. 9 ± 3 cmH2O), duration of mechanical ventilation (5.5 ± 4.8 vs 8.2 ± 10.0 h, p = 0.5), need postoperative respiratory support (2 vs. 1, p = 1), occurrence of pneumopathy (2 vs. 0, p = 0.5) and radiographic atelectasis (7 vs. 8, p = 1). CONCLUSION: No significant difference was observed in EELV after cardiac surgery between not ventilated and ventilated patients during CPB.

Soluble RAGE as a Prognostic Marker of Worsening in Patients Admitted to the ICU for COVID-19 Pneumonia: A Prospective Cohort Study.

Background: The different waves of SARS-CoV-2 infection have strained hospital resources and, notably, intensive care units (ICUs). Identifying patients at risk of developing a critical condition is essential to correctly refer patients to the appropriate structure and to spare limited resources. The soluble form of RAGE (sRAGE), the endoplasmic stress response and its surrogates, GRP78 and VEGF-A, may be interesting markers. Methods: This was a prospective monocenter cohort study of adult patients admitted to the ICU for severe COVID-19 pneumonia. The plasma levels of sRAGE, GRP78 and VEGF-A were measured within the first 24 h. Patients were classified as critical if they further needed vasopressor therapy, renal replacement therapy, or invasive mechanical ventilation, or died during their ICU stay, and were otherwise classified as not critical. Results: A total of 98 patients were included and 39 developed a critical condition. Critical patients presented higher sRAGE (626 [450−1043] vs. 227 [137−404] pg/mL, p < 0.0001), interleukin-6 (43 [15−112] vs. 11 [5−20] pg/mL, p < 0.0001), troponin T (17 [9−39] vs. 10 [6−18] pg/mL, p = 0.003) and NT-pro-BNP (321 [118−446] vs. 169 [63−366] pg/mL, p = 0.009) plasma levels. No difference was observed for VEGF-A and GRP78. The variables independently associated with worsening in the ICU were sRAGE (1.03 [1.01−1.05] per 10 pg/mL) and age (1.7 [1.2−2.4] per 5 years). An sRAGE value of 449.5 pg/mL predicted worsening with a sensitivity of 77% and a specificity of 80%. Conclusion: sRAGE may allow the identification of patients at risk of developing a critical form of COVID-19 pneumonia, and thus may be useful to correctly refer patients to the appropriate structure of care.

Reliability of the Minto model for target-controlled infusion of remifentanil during cardiac surgery with cardiopulmonary bypass.

BACKGROUND: The Minto pharmacokinetic model is used for target-controlled infusion of remifentanil. The reliability of this model has never been evaluated during normothermic cardiac surgery with cardiopulmonary bypass (CPB). The aim of this study was to assess the predictive performance of the model during CPB to determine its reliability during cardiac surgery. METHODS: This was a single-centre observational study. Arterial blood samples were drawn at five time points: T1, after tracheal intubation; T2, immediately before CPB; T3, 10 min after starting CPB; T4, 45 min after starting CPB; T5, 10 min after weaning off CPB. Prediction error (PE) and absolute prediction error (APE) were calculated for each sample and used to determine median prediction error (MDPE) and median absolute prediction error (MDAPE) per patient. Risk factors for APE >30% were assessed using multivariable analysis. Results are presented as medians with inter-quartile ranges. RESULTS: Fifty-eight patients with 283 blood samples (110 during CPB) were included. In the pre-CPB period, MDPE and MDAPE were -17.3 [-32.9 to 2.3] and 24.6 [12-37.7]%, whereas during CPB, they were -1.8 [-15.6 to 11.1] and 14.0 [6.74-27.1]%, respectively. There was no statistically significant difference between measured and predicted remifentanil plasma concentrations during CPB. Age, preoperative albumin concentrations, temperature, and haemodilution were not independently associated with MDAPE >30%. CONCLUSIONS: The Minto model accurately predicts plasma remifentanil concentrations during cardiac surgery with CPB. CLINICAL TRIAL REGISTRATION: 2017-A03153-50.

The Perception of the Anesthesiologist Among the Medical, Paramedical and Administrative Staff.

Introduction: Anesthesia remains a young medical discipline still relatively unknown by the general public and probably by some health professionals. The objective of the study was to evaluate the perception of anesthesiologist by health professionals working with this specialty. Methods: We distributed a computerized survey to physicians, residents, paramedical, midwives, and administrative staff in different hospitals between April and July 2018 in Normandy, France. The survey included 38 questions on 6 different topics: communicated image, skills and knowledge, communication, place in patient care, workload, and initial anesthesiologist formation. The survey was validated by a semi-directive interview methodology. A Likert scale from ×2 to +2 ("completely disagree" to "completely agree") was used for each item. Results: Six hundred and twenty five out of 2,000 surveys sent were analyzed. The anesthesiologist conveys an image of serenity (+0.94 ± 0.79), has a high degree of responsibility (+1.72 ± 0.59) with important decision-making power (+1.39 ± 0.82). He guarantees patient safety and comfort (+1.07 ± 0.88) with his/her dual competence in anesthesia and intensive care (+1.36 ± 0.82). Anesthesiology requires teamwork (+1.68 ± 0.58) and good communication skills (+1.48 ± 0.73). The anesthesiologist is not perceived as a service provider (-0.33 ± 1.15) but is the physician responsible for perioperative care (+1.69 ± 1.00). His/her workload is moderately perceived as high (+0.71 ± 1.17) but is confronted with potentially conflictual relationships with colleagues from other specialties (+1.40 ± 0.68) and stressful situations (+1.44 ± 0.80). Conclusion: The overall perception of the anesthesiologist in our study appears to be good.

The Association Between Professional Accounts on Social Networks Twitter and ResearchGate and the Number of Scientific Publications and Citations Among Anesthesia Researchers: Observational Study.

BACKGROUND: Social networks are now essential tools for promoting research and researchers. However, there is no study investigating the link between presence or not on professional social networks and scientific publication or citation for a given researcher. OBJECTIVE: The objective of this study was to study the link between professional presence on social networks and scientific publications/citations among anesthesia researchers. METHODS: We included all the French full professors and associate professors of anesthesia. We analyzed their presence on the social networks Twitter (professional account with ≥1 tweet over the 6 previous months) and ResearchGate. We extracted their bibliometric parameters for the 2016-2020 period via the Web of Science Core Collection (Clarivate Analytics) database in the Science Citation Index-Expanded index. RESULTS: A total of 162 researchers were analyzed; 42 (25.9%) had an active Twitter account and 110 (67.9%) a ResearchGate account. There was no difference between associate professors and full professors regarding active presence on Twitter (8/23 [35%] vs. 34/139 [24.5%], respectively; P=.31) or ResearchGate (15/23 [65%] vs. 95/139 [68.3%], respectively; P=.81). Researchers with an active Twitter account (median [IQR]) had more scientific publications (45 [28-61] vs. 26 [12-41]; P<.001), a higher h-index (12 [8-16] vs. 8 [5-11]; P<.001), a higher number of citations per publication (12.54 [9.65-21.8] vs. 10.63 [5.67-16.10]; P=.01), and a higher number of citations (563 [321-896] vs. 263 [105-484]; P<.001). Researchers with a ResearchGate account (median [IQR]) had more scientific publications (33 [17-47] vs. 26 [9-43]; P=.03) and a higher h-index (9 [6-13] vs. 8 [3-11]; P=.03). There was no difference between researchers with a ResearchGate account and those without it concerning the number of citations per publication and overall number of citations. In multivariate analysis including sex, academic status, and presence on social networks, the presence on Twitter was associated with the number of publications (ß=20.2; P<.001), the number of citations (ß=494.5; P<.001), and the h-index (ß=4.5; P<.001). CONCLUSIONS: Among French anesthesia researchers, an active presence on Twitter is associated with higher scientific publication and citations.

Myeloid phenotypes in severe COVID-19 predict secondary infection and mortality: a pilot study.

BACKGROUND: De-regulated host response to severe coronavirus disease 2019 (COVID-19), directly referring to the concept of sepsis-associated immunological dysregulation, seems to be a strong signature of severe COVID-19. Myeloid cells phenotyping is well recognized to diagnose critical illness-induced immunodepression in sepsis and has not been well characterized in COVID-19. The aim of this study is to review phenotypic characteristics of myeloid cells and evaluate their relations with the occurrence of secondary infection and mortality in patients with COVID-19 admitted in an intensive care unit. METHODS: Retrospective analysis of the circulating myeloid cells phenotypes of adult COVID-19 critically ill patients. Phenotyping circulating immune cells was performed by flow cytometry daily for routine analysis and twice weekly for lymphocytes and monocytes subpopulations analysis, as well as monocyte human leukocyte antigen (mHLA)-DR expression. RESULTS: Out of the 29 critically ill adult patients with severe COVID-19 analyzed, 12 (41.4%) developed secondary infection and six patients died during their stay. Monocyte HLA-DR kinetics was significantly different between patients developing secondary infection and those without, respectively, at day 5-7 and 8-10 following admission. The monocytes myeloid-derived suppressor cells to total monocytes ratio was associated with 28- and 60-day mortality. Those myeloid characteristics suggest three phenotypes: hyperactivated monocyte/macrophage is significantly associated with mortality, whereas persistent immunodepression is associated with secondary infection occurrence compared to transient immunodepression. CONCLUSIONS: Myeloid phenotypes of critically ill COVID-19 patients may be associated with development of secondary infection, 28- and 60-day mortality.

Gender differences in professional social media use among anaesthesia researchers.

BACKGROUND: Recent studies suggest that female researchers are less visible on social media. The objective of this observational work was to compare the use of professional social networks between male and female anaesthesia researchers. METHODS: Among four anaesthesia journals, we analysed the first/last authors (FA/LA) of the most frequently cited articles in 2016-2017 and the authors who published more than one article per year between 2013 and 2018 (prolific authors). We compared the use of the professional social networks Twitter, LinkedIn, and ResearchGate by the selected authors and analysed the proportion of women in FA and LA position. The variables are presented as median (inter-quartile range). RESULTS: The analysis included 260 FA, 232 LA, and 297 prolific authors. Despite similar declared skills and number of citations, women had lower scientific reputation scores on ResearchGate (RG score: 32.0 [24.4-41.1] vs 20.3 [15.1-29.2]; P<0.0001 in the FA group; 39.3 [34.3-43.4] vs 35.7 [30.3-39.5], P<0.01 in the LA group; and 41.5 [35.6-45.7] vs 36.8 [28.1-42.7], P<0.01 in the prolific group). In all groups, women were significantly less followed on ResearchGate than men. In the three groups, the Twitter (22.7%, 25.0%, and 23.6%, respectively) and LinkedIn (59.2%, 56.5%, and 62.3%, respectively) usage rate were similar with no difference between men and women in each group. Of the 260 articles included, 94 (36.2%) manuscripts had female FA, whereas 41 (15.8%) had female LA. CONCLUSION: In anaesthesia, the visibility of female researchers on the social network dedicated to scientific research is lower than that of male researchers.

A Weak Response to Endoplasmic Reticulum Stress Is Associated With Postoperative Organ Failure in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass.

Introduction: Endoplasmic reticulum stress (ERS) is involved in inflammatory organ failure. Our objective was to describe ERS, its unfolded protein response (UPR) expression/kinetics during cardiac surgery with cardiopulmonary bypass (CPB) and its association with postoperative organ failure (OF). Methods: Prospective study conducted on patients undergoing cardiac surgery with CPB. Blood samples were taken before (Pre-CPB), 2 h (H2-CPB) and 24 h (H24-CPB) after CPB. Plasma levels of 78 kDa Glucose- Regulated Protein (GRP78, final effector of UPR) were evaluated by ELISA. The expression of genes coding for key elements of UPR (ATF6, ATF4, sXBP1, CHOP) was evaluated by quantitative PCR performed on total blood. OF was defined as invasive mechanical ventilation and/or acute kidney injury and/or hemodynamic failure requiring catecholamines. Results: We included 46 patients, GRP78 was decreased at H2-CPB [1,328 (878-1,730) ng/ml vs. 2,348 (1,655-3,730) ng/ml Pre-CPB; p < 0.001] but returned to basal levels at H24-CPB [2,068 (1,436-3,005) ng/ml]. The genes involved in UPR had increased expression at H2 and H24. GRP78 plasma levels in patients with OF at H24-CPB (n = 10) remained below Pre-CPB levels [-27.6 (-51.5; -24.2)%] compared to patients without OF (n = 36) in whom GRP78 levels returned to basal levels [0.6 (-28.1; 26.6)%; p < 0.01]. H24-CPB ATF6 and CHOP expressions were lower in patients with OF than in patients without OF [2.3 (1.3-3.1) vs. 3.0 (2.7-3.7), p < 0.05 and 1.3 (0.9-2.0) vs. 2.2 (1.7-2.9), p < 0.05, respectively]. Conclusions: Low relative levels of GRP78 and weak UPR gene expression appeared associated with postoperative OF. Further studies are needed to understand ERS implication during acute organ failure in humans.