Bourges

Researchers are studying patients with community-acquired pneumonia who need oxygen therapy due to acute respiratory distress and low blood oxygen levels. This research aims to see if placing patients in a prone position lying face down while they receive nasal high flow oxygen can reduce the need for intubation and improve outcomes. The study particularly excludes patients with COVID-19 and focuses on non-COVID pneumonia cases. Participants will be randomly assigned to one of two groups. One group will be encouraged and assisted to lie in the prone position for at least 8 hours per day in multiple sessions, aiming for up to 16 hours if tolerated. The other group will receive usual care with nasal high flow oxygen therapy but no prone positioning. Both groups will have oxygen levels monitored and care adjusted to maintain target oxygen saturation. During the study, patients will be observed for intubation rates within 28 days, comfort levels during prone positioning, oxygenation changes, time to escalation of breathing support, and overall outcomes including mortality up to 90 days. Safety measures like skin and infection monitoring will also be recorded. Quality of life will be assessed at 90 days and 5 years, with nursing workload tracked within the first day after randomization.

This research aims to improve genetic counseling by classifying gene variants found in families with a history of hereditary cancers, especially breast and ovarian cancer. Initially focused on BRCA1 and BRCA2 genes, the study now includes multiple genes from a large French oncogenetics database, covering thousands of families and variants. The goal is to better understand which gene variants are linked to cancer risk and to refine how these variants are classified for clinical use. Participants include index cases carrying specific gene variants and their family members. The study collects saliva samples from relatives to test for the presence of these variants, particularly those classified as uncertain significance class 3, likely pathogenic class 4, or hypomorphic pathogenic class 5. Genetic analyses are performed by specialized laboratories, and data from multiple families is combined to assess how these variants co-segregate with cancer occurrence. Throughout the study, researchers analyze genetic data using statistical models to estimate the likelihood that certain variants cause cancer. They use anonymous results for overall variant classification and share findings with families when variants are found to be pathogenic. This helps guide genetic counseling, possible preventive measures, and clinical management. The study spans up to 15 years and continuously updates classification methods and clinical recommendations based on new data.

Researchers are conducting an observational study called the France PCI Registry to monitor and improve care in interventional cardiology, focusing on procedures like coronary angiography and angioplasty. This national observatory started in 2014 in the Centre Val de Loire region and aims to build a reliable database of interventional cardiology activities. The study is led by the Club Rgional des Angioplasticiens de la rgion Centre and seeks to optimize patient care times, especially for those with STEMI a type of heart attack. The study collects data fully integrated with usual coronary activity reporting software across multiple catheterization labs. It tracks interventional cardiology activities over a year and monitors secondary outcomes such as improving care times for STEMI patients within 24 hours. There are no investigational drugs or treatments administered, as this is an observational study gathering information from routine clinical practice. Participants who have undergone coronary angiograms or angioplasty are involved through data collection during their usual care. The study regularly evaluates data quality to maintain an exhaustive and reliable database. Researchers measure the volume and quality of interventional cardiology procedures and how quickly STEMI patients receive care. Participation lasts as long as the data collection period, with ongoing observation but no additional interventions or treatments.

In intensive care units, patients often need central venous catheters for care and safe medication delivery, but these devices can lead to infections. Most prevention focuses on how catheters are inserted and handled, but the length of time the catheter stays in place is a main source of infection. This research compares changing infusion sets every 7 days versus every 4 days to see if less frequent changes increase infection risk while considering impacts on nursing workload and costs. The study involves two groups one where infusion sets connected to the catheter are replaced every 7 days, and another where they are replaced every 4 days, the current standard recommendation. Each replacement involves disconnecting old sets and replacing them with new sterile ones. Both procedures are performed by qualified nurses during the patients ICU stay. Participants are adult ICU patients with a central venous catheter placed less than 72 hours ago and expected to remain for at least 7 days. Researchers will monitor infections related to the catheter from insertion until 48 hours after removal, along with bloodstream infections, catheter colonization, ICU length of stay, mortality, nursing time, and replacement costs. The study follows patients up to 90 days to collect these outcomes and assess the effects of the different replacement schedules.

Researchers are exploring the effects of continuing oral intake versus fasting in adult patients with acute respiratory failure in intensive care units who are not intubated. This trial aims to evaluate whether allowing patients to eat and drink before potential intubation affects the risk of intubation or aspiration-related complications. The study addresses a gap in knowledge as current guidelines lack data on nutritional management for these patients despite common fasting practices and frequent nutritional deficits. Participants are randomly assigned to one of two groups one group continues oral intake of liquids and solid foods without restrictions, supported by nursing assistance and regular oral care, while the other group follows a fasting protocol with no ingestion of food or liquids except minimal water for essential oral medications if needed. Both groups receive intravenous glucose or parenteral nutrition as necessary, and caloric intake is monitored. The study includes a 96-hour primary observation period after randomization. During the study, participants undergo assessments of respiratory status, nutritional intake, and discomfort levels such as thirst and hunger using verbal scales. Researchers monitor intubation rates, mortality, episodes of vomiting during intubation, salivary enzyme levels, and occurrences of pneumonia, renal failure, and hypoglycemia up to 28 days. The trial also tracks electrolyte levels and adverse events, with regular follow-up to evaluate safety and clinical outcomes over time.

Researchers are evaluating a weaning protocol for patients in intensive care who are receiving high-flow nasal oxygen therapy HFNO due to acute hypoxemic respiratory failure. The study aims to find out if following this protocol increases the chances that patients can be successfully weaned off HFNO by Day 7 after randomization. This open-label, multicenter randomized controlled trial compares the new weaning protocol with standard care, focusing on patients who meet certain stability and oxygenation criteria before starting weaning. Participants in the experimental group will have their HFNO settings gradually reduced according to a specific algorithm. The flow will initially remain high while the oxygen concentration FiO2 is decreased every 4 hours if safety targets for respiratory rate and oxygen saturation SpO2 between 92-95% are met. Once FiO2 stabilizes at 0.4, the flow rate is then decreased stepwise every 4 hours. When the flow reaches 40 Lmin and FiO2 is 0.4 for 4 hours, oxygen support may be switched to standard oxygen. In the control group, weaning methods are determined by the treating practitioner. All changes require medical prescription and aim to maintain a minimum SpO2 of 92%. During the study, patients will be monitored up to 28 days, with assessments including respiratory parameters, oxygen use, and safety outcomes. The primary outcome is the rate of successful weaning off HFNO at Day 7, defined as more than 48 hours without HFNO, non-invasive ventilation, or intubation, and survival at Day 7. Secondary outcomes include time to weaning, rates of intubation and non-invasive ventilation, mortality at Day 28, respiratory muscle use, dyspnea progression, and length of intensive care stay. The study includes adults aged 18 to 90 years admitted for new acute respiratory failure and treated with HFNO at high flow and oxygen settings.