Dieppe

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.

Researchers are evaluating the effects of early intravenous high-dose vitamin C combined with vitamin B1 in patients admitted to intensive care after an out-of-hospital cardiac arrest (OHCA) who develop post-cardiac arrest shock. This shock involves heart and blood circulation failure and can lead to multiple organ failure and early death in up to 35% of patients. The study is a phase II multicenter randomized controlled trial designed to assess if vitamin C and vitamin B1 can improve outcomes compared to standard care following OHCA. Participants are randomly assigned to one of two groups. The experimental group receives standard care plus intravenous high-dose vitamin C at 200 mg/kg per day, given as 50 mg/kg every 6 hours for 3 days, starting within one hour after randomization. They also receive intravenous thiamine (vitamin B1) 200 mg twice daily for 3 days. The control group receives standard care according to guidelines, with no high-dose vitamin C during the first 3 days. From day 4, standard vitamin C and thiamine supplementation at lower doses are allowed. During the 28-day participation, patients are monitored for recovery from the shock, including the need for blood pressure support medications (vasopressors). The primary outcome is the cumulative rate of weaning off vasopressors by day 3 after cardiac arrest. Researchers will also assess safety and recovery progress. The study plans to enroll 234 patients over 24 months, with follow-up lasting 28 days after enrollment.

Gout is a common inflammatory condition caused by high levels of uric acid that leads to painful joint attacks and can result in chronic joint damage, kidney problems, and increased heart risks. This study evaluates whether starting the gout treatment febuxostat immediately during an acute attack is as safe and effective as delaying treatment by six weeks, which is the current recommendation. The trial aims to compare these two approaches in patients diagnosed with gout attacks, focusing on treatment timing and its impact on the disease progression and symptoms. Participants are randomly assigned to two groups: one receives febuxostat 80 mg daily immediately for six weeks, while the other waits six weeks before starting the same treatment. After this initial six-week period, all patients receive febuxostat for an additional six weeks in an extension phase. The study also includes follow-up visits at three and six months to assess ongoing treatment effects. The febuxostat dose does not require adjustment for patients with moderate kidney function (creatinine clearance above 30 ml/min). During the study, patients track the number of days with gout symptoms daily using a booklet and report their pain and overall condition through questionnaires. Doctors perform clinical exams and monitor joint health, blood pressure, and any side effects. Laboratory tests at six and twelve weeks include uric acid, kidney and liver function, inflammation markers, and blood counts to assess treatment safety and effectiveness. The study lasts up to six months with regular assessments to monitor gout attacks and treatment tolerance.

Researchers are evaluating whether an early, personalized rehabilitation program that combines nutritional therapy, physiotherapy, and physical activity can improve long-term outcomes for adults who have been critically ill and required mechanical ventilation and vasopressor therapy in the ICU. This trial compares the effects of this extended rehabilitation approach to usual care given during and after ICU stay. The study includes patients starting invasive mechanical ventilation recently and aims to support recovery from critical illness through tailored interventions. Participants are assigned to either the rehabilitation group or the control group. The rehabilitation group receives a customized program beginning early in the ICU and continuing through the post-ICU hospital stay and then at home for a total of 12 weeks. This program uses goal-directed nutrition and physical activity adjusted over time by specialists including dieticians, physiotherapists, and physical-activity instructors. The control group receives the usual care available at each ICU from day 0 to day 180. Throughout the study, participants will be monitored to assess their recovery progress, with the primary outcome measuring the distance walked in 6 minutes at 6 months. Researchers will gather data on physical function and health improvements during and after the rehabilitation period. The study includes follow-up assessments up to 180 days to evaluate the long-term effects of the rehabilitation program compared to usual care.

De novo hypoxemic acute respiratory failure (hARF) is a leading cause for admission to intensive care units, and intubation in these patients is linked to a significant increase in mortality. Researchers are investigating whether adding continuous positive airway pressure (CPAP) to high-flow nasal cannula (HFNC) oxygen therapy can reduce the need for intubation and lower mortality compared to HFNC alone. This trial is a prospective, randomized controlled study focusing on this approach in patients with acute hypoxemic respiratory failure. Participants will be randomly assigned to one of two groups. One group will receive continuous HFNC oxygen therapy started within one hour after randomization. The other group will receive HFNC combined with CPAP sessions, which provide positive airway pressure to help keep the lungs open without adding inspiratory pressure. CPAP is expected to be better tolerated over long periods and may reduce lung injury risks. This study aims to compare the impact of these two oxygen therapy strategies on patient outcomes. During the study, patients will be closely monitored in the ICU with assessments focusing on mortality within 90 days. Researchers will track respiratory signs, oxygen levels, and overall clinical status. The goal is to determine whether adding CPAP to HFNC improves survival without increasing complications. Study participation involves standard ICU care with these respiratory therapies and continuous evaluation of patient response over the treatment period.

Researchers are investigating the best target for mean arterial pressure (MAP) to improve brain function after out-of-hospital cardiac arrest, a critical condition with low survival rates. Brain injury after cardiac arrest is a major cause of death and disability, often worsened by low blood flow to the brain early after circulation returns. This study compares a standard MAP target of at least 65 mmHg with a higher target of at least 90 mmHg to see if raising MAP can improve neurological outcomes within 180 days after the event. Participants in the study will be randomly assigned to receive norepinephrine to maintain either a MAP of at least 65 mmHg or a MAP of at least 90 mmHg for the first 24 hours after inclusion. This intervention aims to ensure sufficient blood flow to the brain while avoiding potential risks from too high blood pressure. The study monitors the effects of these two MAP targets during the critical early period after cardiac arrest. During the study, patients will be closely monitored in intensive care with assessments focused on their neurological function 180 days after the cardiac arrest. Researchers will evaluate the proportion of patients who achieve good neurofunctional outcomes. The study includes careful follow-up and recording of clinical data to understand the impact of different MAP targets on survival and brain recovery after this serious event.

Obesity is a growing public health issue, and lasting weight loss can be challenging despite dietary advice, physical activity, and psychological support. Bariatric surgery, combined with education and medical monitoring, can lead to significant and lasting weight loss for patients who have not succeeded with medical treatment and have a body mass index (BMI) of 40 or higher, or a BMI of 35 or higher with related health problems such as type 2 diabetes or high blood pressure. Surgeons often face difficulties due to excess abdominal fat and an enlarged, fatty liver before surgery. This research is studying the effects of a low-calorie, high-protein diet given for four weeks before bariatric surgery. Participants will either follow this special diet or not before their scheduled sleeve gastrectomy. The diet aims to reduce liver size and fat load quickly, potentially easing the surgical procedure and lowering complications. The study involves a team of dietitians, surgeons, and physicians to support and monitor the diet. During the study, participants will be closely monitored, including assessments of diet tolerance four weeks after starting the diet. Researchers will collect data to help estimate the risk of undernutrition and evaluate the diet's safety and impact. This approach may standardize preoperative care, improve surgery outcomes, and reduce risks such as infections or longer hospital stays. The study includes medical and dietary monitoring and requires participants to follow the diet for a month before surgery.

Researchers are evaluating a range of treatments to improve outcomes for adults admitted to intensive care units (ICUs) with severe community-acquired pneumonia (CAP), including cases caused by influenza and COVID-19. This Phase 3 adaptive platform trial, REMAP-CAP, is designed to test multiple treatment strategies simultaneously and adapt over time, allowing new treatments to be added as questions are answered. The trial also serves as a platform to quickly evaluate treatments during respiratory pandemics, such as COVID-19, through a sub-study called REMAP-COVID in the United States. Participants receive various interventions including antibiotics like ceftriaxone, moxifloxacin, or piperacillin-tazobactam, as well as macrolide therapies given for different durations. Other treatments assessed include corticosteroids such as hydrocortisone and dexamethasone, antiviral agents like oseltamivir and remdesivir, immune modulators including tocilizumab and baricitinib, and supportive care strategies such as mechanical ventilation methods. Dosing and duration vary for each treatment, with some interventions now closed. Treatments are administered according to local guidelines and clinical decisions, with some requiring intravenous or enteral routes. Participants are closely monitored with assessments focusing on survival and organ support status in the ICU up to 90 days after enrollment. The main outcomes measured include all-cause mortality by day 90 and the number of days alive without needing organ support in the ICU by day 21. The study collects data continuously to adapt treatment assignments for new participants, aiming to identify the most effective therapies. Follow-up and safety monitoring continue throughout hospitalization and up to 90 days after admission.

Researchers are evaluating a screening method for hepatitis B, hepatitis C, and AIDS viruses among drug users. The study aims to identify active infections of these viruses using a simple blood collection technique. It focuses on individuals with a history of intravenous or nasal drug use, including those receiving opiate substitution therapy. The study uses a Dried Blood Spot method for blood collection to screen participants for hepatitis B, hepatitis C, and AIDS viruses. This approach allows for easier sample collection and testing in this population. The intervention involves collecting blood samples on special filter paper to detect active infections. Participants are involved in one screening visit where their blood is collected using the Dried Blood Spot method. Researchers will assess the presence of active hepatitis B, hepatitis C, and AIDS infections on the first day. The study monitors the number of individuals with active infections as primary outcomes. The total participation time is focused on this initial screening event.

Researchers are collecting detailed information about adults who experience convulsive or non-convulsive status epilepticus, a serious condition involving prolonged or repeated seizures. This registry study records data on the circumstances of seizure onset, clinical features, treatments given before and during hospital care, diagnostic test results, and causes of the seizures. The study aims to track outcomes for these patients over time to better understand this condition and its management. Participants in this study are adults aged 18 years or older diagnosed with status epilepticus lasting 5 minutes or more, either as continuous seizures or repeated seizures without full recovery between them. Data collection involves standardized forms capturing demographic details, timing of seizures and treatments, EEG monitoring results, and other clinical information. The study includes follow-up assessments at ICU and hospital discharge, as well as at 90 days and one year after the seizure event. Throughout the study, researchers gather clinical findings, laboratory and EEG results, and treatment information from hospital and pre-hospital sources. They evaluate patient outcomes using measures like vital status and the Glasgow Outcome Scale at multiple time points, including up to one year after the seizure. This comprehensive data helps monitor recovery and long-term effects of status epilepticus in critically ill patients.