Dieppe

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.

Researchers are investigating the use of high-dose intravenous vitamin C combined with thiamine vitamin B1 to manage post-cardiac arrest shock in patients admitted to intensive care units after out-of-hospital cardiac arrest. This condition often leads to cardiac and circulatory failure, causing multi-organ failure and early death in a significant portion of patients. The study is a phase II, multicenter, randomized controlled trial comparing standard care with the addition of high-dose vitamin C and thiamine to assess potential benefits on shock recovery and neurological outcomes. Participants are randomly assigned to one of two groups the control group receiving standard post-cardiac arrest care according to international guidelines, and the experimental group receiving standard care plus high-dose intravenous vitamin C at 50 mgkg every 6 hours for 3 days, starting within an hour after randomization, along with intravenous thiamine 200 mg twice daily for 3 days. From day 4 onwards, standard vitamin C supplementation up to 1000 mg daily and thiamine are allowed in both groups. During the 28-day participation period, patients will be closely monitored for recovery from shock, neurological function, and organ failure. Assessments include measuring the time to stop vasopressors by day 3, survival rates related to shock by day 7, neurological status at day 28, maximum vasopressor doses within 3 days, changes in organ failure scores, and arterial lactate levels. Safety and effectiveness data will be collected throughout to evaluate the impact of the vitamin C and thiamine treatment alongside standard care.

Gout is a common inflammatory condition caused by high levels of uric acid leading to painful joint attacks and potentially chronic joint damage, kidney failure, and cardiovascular problems. This trial investigates whether starting febuxostat, a urate-lowering medication, immediately after an acute gout attack is as safe and effective as the current practice of delaying treatment by six weeks. The study aims to better understand if early treatment can prevent worsening of gout and its complications without increasing early relapses. Participants are randomly assigned to one of two groups one begins febuxostat treatment immediately at 80 mg daily for 12 weeks, and the other starts febuxostat only after a six-week delay. The study includes an initial 6-week comparison period, followed by an extension phase where all participants receive febuxostat, and a final evaluation at six months to assess ongoing treatment effects. Febuxostat is chosen for its potency and suitability for patients with moderate kidney issues. Throughout the study, participants will report daily gout symptoms and pain levels using a diary and visual scales. Physical and joint examinations, blood tests to monitor uric acid and inflammation, and assessments of physical function will occur at 2, 6, 12, and 26 weeks. Researchers will track the number of days with gout attacks, treatment tolerance, and overall patient well-being to compare early versus delayed febuxostat use. The study is conducted with blinded evaluators to ensure unbiased results.

Researchers are evaluating how an early and extended rehabilitation program that combines personalized nutritional therapy, physiotherapy, and physical activity can improve long-term outcomes for patients who have undergone invasive mechanical ventilation and vasopressor therapy in the ICU. This trial compares the effects of this tailored rehabilitation program to usual care, aiming to support recovery from critical illness. The study is a multicenter randomized controlled trial led by Nantes University Hospital. Participants will be assigned randomly to either the rehabilitation group or the usual care group. Those in the rehabilitation group receive a customized program starting early in the ICU and continuing through the post-ICU ward and at home for 12 weeks. This program involves goal-directed nutrition and physical activities adjusted to each patients progress, with support from dieticians, physiotherapists, and physical activity instructors. The usual care group receives standard nutritional support and physiotherapy based on local practices from day 0 to day 180. Throughout the study, participants will undergo various assessments including walking distance measured by a 6-minute walk test at 6 months, muscle strength, muscle mass, physical activity levels, calorie and protein intake, body weight, mortality rates, blood glucose monitoring, and quality of life surveys. These evaluations occur at multiple time points during and after hospitalization, up to one year. The study includes careful monitoring of mechanical ventilation duration, infections, hospital stay lengths, and other safety outcomes. Participant involvement spans from ICU admission through long-term follow-up.

De novo hypoxemic acute respiratory failure hARF is a leading cause of admission to intensive care units ICU and is associated with a high risk of death when intubation is needed. Researchers are evaluating whether adding continuous positive airway pressure CPAP to high flow nasal cannula HFNC oxygen therapy can reduce mortality compared to HFNC alone. The trial is a prospective, randomized controlled study focused on patients with de novo acute hypoxemic respiratory failure. Participants will be randomly assigned to one of two groups. One group will receive continuous HFNC oxygen started within one hour after randomization. The other group will receive HFNC combined with CPAP sessions, which provide positive airway pressure to help keep lungs open without added breathing support. The study compares these two oxygenation strategies to see their impact on patient outcomes. During the study, patients will be closely monitored for 90 days to assess mortality and other outcomes such as time to intubation, breathing difficulty, respiratory rate, and tolerance of oxygen therapy. Additional measures include length of ICU and hospital stay, incidence of infections, and number of days free from invasive ventilation or HFNC. Various clinical assessments and blood tests may be performed as needed. The study aims to gather detailed information on safety and effectiveness of the combined CPAP plus HFNC approach over several months.

Out-of-hospital cardiac arrest is a serious health issue with survival rates below 10%. The main cause of death in intensive care units after such an event is post-cardiac arrest syndrome, which leads to shock or brain injury due to lack of oxygen. Brain injury may worsen if blood flow is not properly maintained in the first hours after the heart starts beating again. This research aims to compare two blood pressure targets to see if higher blood pressure after cardiac arrest improves brain function recovery. Participants will be randomly assigned to one of two groups. One group will receive treatment to keep their mean arterial pressure MAP at or above 90 mmHg for 24 hours using norepinephrine. The other group will have a standard target MAP of at least 65 mmHg for 24 hours with the same medication. After the initial 24 hours, both groups will aim for MAP of 65 mmHg until they leave the ICU. During the study, patients will be monitored for brain function and survival for up to 180 days. Researchers will evaluate neurological outcomes, survival rates at various points, quality of life, frailty, and kidney function. The study includes measurement of days without ICU stay, ventilator, or kidney therapy. Safety and long-term outcomes will be assessed to understand the effects of different blood pressure targets after cardiac arrest.

Obesity is a growing public health issue that can be difficult to treat through diet, exercise, and managing psychological challenges alone. Bariatric surgery is an option for patients with a body mass index BMI of 40 or higher, or 35 or higher with related health problems like type 2 diabetes or sleep apnea, when other treatments have failed. A common surgical challenge is the increased fat and size of the liver, which can complicate the procedure. This research evaluates the effects of a low-calorie, high-protein diet taken for four weeks before bariatric surgery. One group will follow this diet to reduce liver fat and size, while another group will not follow the diet. The diet aims to make surgery easier and safer by reducing fat load and improving surgical conditions. Participants will be monitored before and after surgery with assessments of diet tolerance, weight loss, muscle strength, quality of life, physical activity, digestive tolerance, and surgical outcomes such as operating time and complications. The study includes follow-ups up to three months after surgery and tracks hospital stay length and post-surgery complications, with the total observation lasting four months after surgery.

Researchers are evaluating treatments for community-acquired pneumonia CAP, especially in patients admitted to intensive care units ICUs. This trial also adapts to study treatments for respiratory pandemics like COVID-19. The goal is to determine which treatment strategies improve outcomes for patients with severe pneumonia, using a flexible, ongoing approach that can test multiple therapies simultaneously and update as new information becomes available. Participants receive different treatment strategies based on random assignment to study groups. Treatments include various antibiotics, steroids, antivirals, immune modulators, anticoagulation methods, and ventilation strategies. Some treatment options have been closed to recruitment, reflecting the trials adaptive nature. The trial includes several domains targeting specific infections such as influenza and COVID-19, with dosing and duration guided by clinical practice and local guidelines. During the study, participants are monitored closely with assessments including survival up to 90 days, days alive without organ support in ICU, ICU and hospital length of stay, ventilator-free days, organ failure-free days, and quality of life up to 6 months. Researchers collect detailed data on patient outcomes, organ support needs, and hospital discharge status. The study runs until February 2028, with ongoing evaluation to improve pneumonia treatment strategies in ICU settings and during respiratory pandemics.

This research aims to screen people who use drugs for hepatitis B, hepatitis C, and AIDS viruses. It focuses on identifying active infections using a simple blood collection method. The study is sponsored by the University Hospital, Rouen, and does not involve experimental drug treatments but diagnostic testing. Participants will have their blood collected using a Dried Blood Spot method, which is a minimally invasive way to collect samples. The study includes individuals who are former or current intravenous or nasal drug users, as well as those on opiate substitution therapy. The screening occurs at the start of participation to detect active infections. Participants will be assessed on the first day for active hepatitis B, hepatitis C, and AIDS infections. The main measurements are the number of individuals found to have active infections of these viruses. This study does not involve any treatment and focuses on diagnostic testing and data collection during the initial visit.

Researchers are collecting detailed data on adults experiencing convulsive and non-convulsive status epilepticus SE or pseudo status epilepticus. This observational study aims to understand the circumstances, treatment, and outcomes of SE in critically ill patients by gathering extensive clinical and demographic information. The study is sponsored by the Ictal Group and tracks patient progress up to one year after SE onset. Participants with SE are observed without intervention, focusing on data collection such as seizure onset, treatment timing, EEG monitoring results, and seizure characteristics. The study includes both convulsive and non-convulsive SE cases, as well as pseudo SE, using standardized forms to document pre-hospital and hospital care details. Outcome evaluations are scheduled at ICU and hospital discharge, and follow-ups occur at 90 days and one year after SE. During the study, participants vital status and neurological outcomes are assessed using the Glasgow Outcome Scale at multiple timepoints. Researchers also monitor seizure recurrence, total seizure duration, and length of hospital stay. The study tracks mortality rates at ICU and hospital discharge and up to ten years in secondary measures. Data collection includes patient chart reviews and phone interviews to ensure comprehensive follow-up over time.