Bourges

Researchers are studying adults with community-acquired pneumonia who need oxygen therapy due to acute respiratory failure meeting acute respiratory distress syndrome (ARDS) criteria. This condition often leads to tracheal intubation and poor outcomes. Previous studies showed that prone positioning reduces mortality in invasively ventilated ARDS patients and improves oxygenation in non-intubated patients with viral pneumonia, including COVID-19 cases. This trial focuses on patients with non-COVID community-acquired pneumonia using nasal high flow therapy, aiming to see if awake prone positioning can reduce the need for intubation and related treatments like sedation and muscle relaxation. Participants will be encouraged to spend as much time as possible in the prone position, ideally 4 to 8 hours per session, with a goal of up to 16 hours or more within each 24-hour period, depending on their tolerance. This intervention is compared to usual care without prone positioning. The study excludes patients with recent COVID-19 infection or those requiring immediate intubation. During the study, researchers will monitor patients for up to 28 days after randomization, focusing on whether they require intubation. Participants will be admitted to an intensive care or intermediate care unit, and their oxygen levels will be closely assessed using the PaO2/FiO2 ratio or equivalent SpO2/FiO2 measurements. Consent and social security affiliation are required. Safety and effectiveness of awake prone positioning in reducing intubation needs will be evaluated throughout the study period.

This research investigates the impact of an early inhaled sedation strategy using Isoflurane delivered by an ANACONDA132; system compared to a conventional intravenous sedation method in intensive care patients who require invasive mechanical ventilation. The study focuses on preventing delirium, a common and serious complication in ventilated patients, by exploring sedation approaches in a Phase 3 clinical trial setting. Delirium is linked to worsened outcomes, including longer ventilation and hospital stays, and potential long-term cognitive effects. Participants receive either sedation through inhaled Isoflurane combined with analgesic drugs or conventional intravenous sedation with propofol and analgesics. Both groups use nurse-driven analgesia protocols including pain assessment scores and various pain management options such as opioids and non-opioid adjuncts. Sedation starts early, either at rapid sequence induction if intubated in intensive care or upon admission if pre-hospital intubation occurred. Throughout the study, patients are monitored for the occurrence of delirium within 28 days. Researchers assess comfort, safety, sedation effectiveness, and other clinical outcomes. Consent is obtained from patients or relatives, and sedation and analgesia are carefully managed using standardized protocols. The study excludes patients with certain neurological conditions, severe respiratory distress, and other specific criteria to ensure safety and reliable assessment of the sedation strategies.

Researchers are studying gene variants of uncertain significance (VUS) found in genes linked to hereditary breast, ovarian, and other cancers. The goal is to better classify these VUS using data from a large French genetic database to improve genetic counseling and help guide clinical decisions, including preventive surgeries. The study originally focused on BRCA1 and BRCA2 genes but now includes multiple cancer-related genes identified through ongoing genetic testing in French families. Participants include index cases who carry specific VUS classified as uncertain or likely causal, along with their selected family members. Saliva samples are collected from these relatives to test for the presence of the variants. The study uses co-segregation analysis, which examines how the variant tracks with disease within families, applying a Bayesian model alongside other genetic and clinical data to estimate the likelihood that a variant causes cancer. Participants provide informed consent and saliva samples for genetic testing. Researchers compile data from multiple families to strengthen the classification of variants. The primary outcome is to perform co-segregation analysis over a period of up to 15 years. This long-term study aims to refine the clinical relevance of genetic variants to support personalized cancer risk assessment and counseling for affected families.

Rigorous assessment of clinical practice plays an important role in improving patient care and outcomes in interventional cardiology. This multicenter observational study called CRAC began in 2014 in the Centre Val de Loire region of France. It uses usual coronary activity report software to collect high-quality, reliable data from five interventional cardiology catheterization labs in the region. This approach aims to create an extensive and trustworthy database that could be expanded to other regions in France. The study collects data continuously from patients who have undergone coronary angiograms or angioplasty procedures. There are no specific interventions or treatments assigned as this is an observational registry monitoring routine clinical activity in interventional cardiology. The data collection and quality assessment are integrated into the regular reporting systems used by participating centers. Participants provide their data while receiving standard care. Researchers regularly evaluate the quality of the collected data to ensure accuracy and completeness. The main outcome being measured is the census of interventional cardiology activity over one year. The study focuses on building a comprehensive national registry to support improved care through careful monitoring and analysis of interventional cardiology procedures.

Patients in intensive care units often require a central venous catheter to deliver medications safely. These catheters, however, can sometimes cause infections, especially the longer they remain in place. Most prevention efforts focus on how the catheter is inserted and handled, but less attention is given to how long the catheter and its connected infusion sets stay in place, which is a key factor in infection risk. This research compares two schedules for changing the infusion sets connected to central venous catheters. One group will have their infusion sets replaced every 7 days, while the other group will follow the usual practice of replacing them every 4 days. During each replacement, all tubing and connectors will be disconnected and swapped with new sterile equipment to reduce contamination risk. Participants will be monitored from catheter insertion until 48 hours after removal, or up to 90 days in the ICU, to track infection rates related to the catheters. Researchers will collect data on infection complications and assess whether the less frequent 7-day replacement increases infection risk compared to the standard 4-day schedule. This study also considers the impacts on nursing workload and medical resource use.

Researchers are investigating the effects of continuing oral intake versus fasting in adult patients with acute respiratory failure who are hospitalized in intensive care units but are not intubated. The study addresses a gap in current ICU nutrition guidelines, as fasting is commonly practiced despite limited scientific evidence, and patients often suffer from caloric deficits and discomfort such as hunger and thirst. The trial explores whether allowing oral intake before potential intubation increases risks such as aspiration or the need for intubation. Participants will be assigned to one of two groups: those allowed to eat and drink freely according to their tolerance, and those who will fast without any oral intake of liquids or solid foods. This approach aims to compare the safety and outcomes of maintaining nutritional support versus fasting in this specific patient population at risk of intubation. Throughout the study, researchers will monitor the percentage of patients who require intubation or die without intubation within 96 hours after randomization. Patient well-being, risk of aspiration, and respiratory status will be closely evaluated. The trial includes detailed assessments and continuous monitoring during the ICU stay to understand the impact of oral intake continuation on clinical outcomes and patient comfort.

Researchers are evaluating a protocol to help patients in intensive care units stop using high-flow nasal oxygen therapy (HFNO) more successfully. This study focuses on adults with acute hypoxemic respiratory failure who have been receiving HFNO for at least 24 hours. The goal is to increase the chances of patients being fully weaned from HFNO by Day 7 after starting the protocol, meaning they no longer need HFNO or other breathing support and are still alive at that time. The study compares two groups of patients: one group uses a specific weaning protocol that gradually lowers oxygen flow and concentration based on oxygen saturation and breathing rate, while the other group receives standard care where the weaning method is chosen freely by the healthcare provider. The weaning process begins once patients meet all the criteria for starting it. Patients will be monitored closely up to 28 days after randomization. Participants will be carefully observed with tests including blood gas measurements and monitoring of oxygen levels and respiratory rates. Researchers will track whether patients successfully stop HFNO by Day 7 and remain off it without needing additional ventilation support. The study will also ensure patient safety and follow their progress during the 28-day monitoring period to assess the protocol's effectiveness.