Thoracic epidural analgesia in intensive care unit patients with acute pancreatitis: the EPIPAN multicenter randomized controlled trial

Matthieu Jabaudon; Alexandra Genevrier; Samir Jaber; Olivier Windisch; Stéphanie Bulyez; Pierre-François Laterre; Etienne Escudier; Achille Sossou; Philippe Guerci; Pierre-Marie Bertrand; Pierre-Eric Danin; Martin Bonnassieux; Leo Bühler; Claudia Paula Heidegger; Russell Chabanne; Thomas Godet; Laurence Roszyk; Vincent Sapin; Emmanuel Futier; Bruno Pereira; Jean-Michel Constantin; Elodie Caumon; Julien Amat; Dominique Morand; Renaud Guérin; Sébastien Perbet; Benjamin Rieu; Sophie Cayot; Christian Chartier; Camille Verlhac; Christine Rolhion; Justine Bourdier; Bernard Cosserant; Raiko Blondonnet; Jean-Baptiste Joffredo; Thomas Costilles; Damien Bouvier; Lise Bernard; Jean-Etienne Bazin; Lydie Marie-Anne; Raphaël Giraud; Annick Puchois; Cyril Boronad; Marine Agullo; Boris Jung; Gérald Chanques; Cécile Spirito; Marion Monnin; Albert Prades; Moussa Cisse; Anne Verchere; Claudine Gniadek; Fouad Belafia; Daniel Verzilli; Julie Carr; Audrey de Jong; Yannael Coisel; Jean-Marc Delay; Matthieu Conseil; Marie Gonzalez; Delphine Rosant; Michel Prevot; Bernard Claud; François Brenas; Lassane Zanre; Philippe Bray; Hélène Riera; Emilie Gadea-Deschamps; Pablo Massanet; Caroline Boutin; Saber Barbar; David-Paul de Brauwere; Serge Lumbroso; Amélie Maurin; Sophie Lloret; Laurent Muller; Claire Roger; Jean-Yves Lefrant; Loubna Elotmani; Audrey Ayral; Suzanne Renard; Nadège Bouskila; Gaspard Beaune; Magali Farines-Raffoul; Marie Lebouc; Auguste Dargent; Thomas Crozon; Julien Clauzel; Marinne Le Core; Thomas Rimmelé

doi:10.1186/s13054-023-04502-w

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Thoracic epidural analgesia in intensive care unit patients with acute pancreatitis: the EPIPAN multicenter randomized controlled trial

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Thoracic epidural analgesia in intensive care unit patients with acute pancreatitis: the EPIPAN multicenter randomized controlled trial

Matthieu Jabaudon, Alexandra Genevrier, Samir Jaber, Olivier Windisch, Stéphanie Bulyez, Pierre-François Laterre, Etienne Escudier, Achille Sossou, Philippe Guerci, Pierre-Marie Bertrand, …

Critical Care, Vol.27(1)

12/2023

DOI: https://doi.org/10.1186/s13054-023-04502-w

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Abstract Background Findings from preclinical studies and one pilot clinical trial suggest potential benefits of epidural analgesia in acute pancreatitis. We aimed to assess the efficacy of thoracic epidural analgesia, in addition to usual care, in improving clinical outcomes of intensive care unit patients with acute pancreatitis. Methods A multicenter, open-label, randomized, controlled trial including adult patients with a clinical diagnosis of acute pancreatitis upon admission to the intensive care unit. Participants were randomly assigned (1:1) to a strategy combining thoracic epidural analgesia and usual care (intervention group) or a strategy of usual care alone (control group). The primary outcome was the number of ventilator-free days from randomization until day 30. Results Between June 2014 and January 2019, 148 patients were enrolled, and 135 patients were included in the intention-to-treat analysis, with 65 patients randomly assigned to the intervention group and 70 to the control group. The number of ventilator-free days did not differ significantly between the intervention and control groups (median [interquartile range], 30 days [15–30] and 30 days [18–30], respectively; median absolute difference of − 0.0 days, 95% CI − 3.3 to 3.3; p = 0.59). Epidural analgesia was significantly associated with longer duration of invasive ventilation (median [interquartile range], 14 days [5–28] versus 6 days [2–13], p = 0.02). Conclusions In a population of intensive care unit adults with acute pancreatitis and low requirement for intubation, this first multicenter randomized trial did not show the hypothesized benefit of epidural analgesia in addition to usual care. Safety of epidural analgesia in this setting requires further investigation. Trial registration : ClinicalTrials.gov registration number NCT02126332 , April 30, 2014.

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Titre: Thoracic epidural analgesia in intensive care unit patients with acute pancreatitis: the EPIPAN multicenter randomized controlled trial
Créateurs - sans rôle: Matthieu Jabaudon - Clermont Université
Alexandra Genevrier - Centre Hospitalier Universitaire de Clermont-Ferrand
Samir Jaber - Centre National de la Recherche Scientifique
Olivier Windisch - University Hospital of Geneva
Stéphanie Bulyez - University Hospital of Geneva
Pierre-François Laterre
Etienne Escudier - Centre Hospitalier Annecy Genevois
Achille Sossou - Centre hospitalier Emile Roux
Philippe Guerci - Université de Lorraine
Pierre-Marie Bertrand - Centre Hospitalier de Cannes
Pierre-Eric Danin - Centre Hospitalier Universitaire de Nice
Martin Bonnassieux - Hospices Civils de Lyon
Leo Bühler - University Hospital of Geneva
Claudia Paula Heidegger - University of Geneva
Russell Chabanne - Centre Hospitalier Universitaire de Clermont-Ferrand
Thomas Godet - Centre Hospitalier Universitaire de Clermont-Ferrand
Laurence Roszyk - Clermont Université
Vincent Sapin - Inserm
Emmanuel Futier - Inserm
Bruno Pereira
Jean-Michel Constantin
Elodie Caumon - Centre Hospitalier Universitaire de Clermont-Ferrand
Julien Amat - Centre Hospitalier Universitaire de Clermont-Ferrand
Dominique Morand - Centre Hospitalier Universitaire de Clermont-Ferrand
Renaud Guérin
Sébastien Perbet - Centre Hospitalier Universitaire de Clermont-Ferrand
Benjamin Rieu - Centre Hospitalier Universitaire de Clermont-Ferrand
Sophie Cayot - Centre Hospitalier Universitaire de Clermont-Ferrand
Christian Chartier - Centre Hospitalier Universitaire de Clermont-Ferrand
Camille Verlhac - Centre Hospitalier Universitaire de Clermont-Ferrand
Christine Rolhion - Centre Hospitalier Universitaire de Clermont-Ferrand
Justine Bourdier - Centre Hospitalier Universitaire de Clermont-Ferrand
Bernard Cosserant - Centre Hospitalier Universitaire de Clermont-Ferrand
Raiko Blondonnet - Centre Hospitalier Universitaire de Clermont-Ferrand
Jean-Baptiste Joffredo - Centre Hospitalier Universitaire de Clermont-Ferrand
Thomas Costilles - Centre Hospitalier Universitaire de Clermont-Ferrand
Damien Bouvier - Centre Hospitalier Universitaire de Clermont-Ferrand
Lise Bernard - Centre Hospitalier Universitaire de Clermont-Ferrand
Jean-Etienne Bazin - Centre Hospitalier Universitaire de Clermont-Ferrand
Laurence Roszyk - Clermont Université
Lydie Marie-Anne - Clermont Université
Raphaël Giraud - University Hospital of Geneva
Annick Puchois - Centre Hospitalier de Cannes
Cyril Boronad - Centre Hospitalier de Cannes
Marine Agullo - Centre Hospitalier de Cannes
Boris Jung - Centre Hospitalier de Cannes
Gérald Chanques - Centre Hospitalier Universitaire de Montpellier
Cécile Spirito - Centre Hospitalier Universitaire de Montpellier
Marion Monnin - Centre Hospitalier Universitaire de Montpellier
Albert Prades - Centre Hospitalier Universitaire de Montpellier
Moussa Cisse - Centre Hospitalier Universitaire de Montpellier
Anne Verchere - Centre Hospitalier Universitaire de Montpellier
Claudine Gniadek - Centre Hospitalier Universitaire de Montpellier
Fouad Belafia - Centre Hospitalier Universitaire de Montpellier
Daniel Verzilli - Centre Hospitalier Universitaire de Montpellier
Julie Carr - Centre Hospitalier Universitaire de Montpellier
Audrey de Jong - Centre Hospitalier Universitaire de Montpellier
Yannael Coisel - Centre Hospitalier Universitaire de Montpellier
Jean-Marc Delay - Centre Hospitalier Universitaire de Montpellier
Matthieu Conseil - Centre Hospitalier Universitaire de Montpellier
Marie Gonzalez - Centre Hospitalier Universitaire de Montpellier
Delphine Rosant - Centre Hospitalier Universitaire de Montpellier
Michel Prevot - Centre Hospitalier Régional et Universitaire de Nancy
Bernard Claud - Centre hospitalier Emile Roux
François Brenas - Centre hospitalier Emile Roux
Lassane Zanre - Centre hospitalier Emile Roux
Philippe Bray - Centre hospitalier Emile Roux
Hélène Riera
Emilie Gadea-Deschamps - Centre hospitalier Emile Roux
Pablo Massanet - Centre Hospitalier Universitaire de Nîmes
Caroline Boutin - Centre Hospitalier Universitaire de Nîmes
Saber Barbar - Centre Hospitalier Universitaire de Nîmes
David-Paul de Brauwere - Centre Hospitalier Universitaire de Nîmes
Serge Lumbroso - Centre Hospitalier Universitaire de Nîmes
Amélie Maurin - Centre Hospitalier Universitaire de Nîmes
Sophie Lloret - Centre Hospitalier Universitaire de Nîmes
Laurent Muller - Centre Hospitalier Universitaire de Nîmes
Claire Roger - Centre Hospitalier Universitaire de Nîmes
Jean-Yves Lefrant
Loubna Elotmani - Centre Hospitalier Universitaire de Nîmes
Audrey Ayral - Centre Hospitalier Universitaire de Nîmes
Suzanne Renard - UCLouvain
Nadège Bouskila - UCLouvain
Gaspard Beaune - Centre Hospitalier Annecy Genevois
Magali Farines-Raffoul - Centre Hospitalier Annecy Genevois
Marie Lebouc - Centre Hospitalier Annecy Genevois
Auguste Dargent - Hospices Civils de Lyon
Thomas Crozon - Hospices Civils de Lyon
Julien Clauzel - Hospices Civils de Lyon
Marinne Le Core - Hospices Civils de Lyon
Thomas Rimmelé - Hospices Civils de Lyon
Détails de publication: Critical Care, Vol.27(1)
Identifiants: 99153548709311
Unité académique: Physiologie et Médecine Expérimentale du coeur et des muscles - PhyMedExp
Langue: English
Type de ressource: Journal article
Champs locaux: hal-04112779