Study of the Combined Influence of Sepsis and Mechanical Ventilation on the Human Diaphragm

Study Overview
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Brief Summary
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The aim of this study is to study the combined impact of mechanical ventilation and sepsis on the human diaphragm in order to establish the neutral, protective or destructive character of mechanical ventilation by studying the diameter of the fibers, activation of proteolytic systems, inhibition of protein synthesis, tissue inflammation as well as contractile function.

Official Title
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Study of the Combined Influence of Sepsis and Mechanical Ventilation on the Human Diaphragm

Conditions
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Respiration, Artificial

Intervention / Treatment
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* Procedure: surgery
* Procedure: multi-organ sampling


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient at least 18 years of age, male or female requiring abdominal or thoracic surgery or multi-organ sampling; Affiliated to a social security or similar system; Not subject to legal protection; Having given consent to participate in the study (or consent from the trusted person) Control group (C): non-septic mesocolic programmed abdominal or thoracic surgery: gastrectomy, esophagectomy, pancreatectomy, hepatectomy Sepsis group (S): Abdominal or thoracic surgery in a septic context (peritonitis, mediastinitis, pleural abscess) Group Mechanical Ventilation (MV): Patient in brain death for which a multi organ sample is planned Mechanical Ventilation + Sepsis (S-MV) group: Patient under controlled mechanical ventilation to undergo abdominal or thoracic surgery in a septic context (peritonitis, mediastinitis, pleural abscess) Exclusion Criteria: Pregnant woman (diagnosis of interrogation) severe and / or unbalanced chronic respiratory disease; severe malnutrition Long-term corticosteroids> 5mg / day for more than 1 month Myopathy surgery by laparoscopic By group: Control group: Sepsis, preoperative controlled mechanical ventilation and preoperative hemodynamic instability Mechanical Ventilation Group: Sepsis, duration of controlled mechanical ventilation <24 hours or> 7 days Sepsis Group: Preoperatively controlled mechanical ventilation Mechanical Ventilation - Sepsis Group: duration of controlled mechanical ventilation <24 hours or> 7 days

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: control group<br>non-septic mesocolic programmed abdominal or thoracic surgery: gastrectomy, esophagectomy, pancreatectomy, hepatectomy | Procedure: surgery<br>* a diaphragmatic biopsy (100 microgram) and a parietal biopsy will be performed by the surgeon during surgery.<br>|
| Experimental: sepsis group<br>Abdominal or thoracic surgery in a septic context (peritonitis, mediastinitis, pleural abscess) | Procedure: surgery<br>* a diaphragmatic biopsy (100 microgram) and a parietal biopsy will be performed by the surgeon during surgery.<br>|
| Experimental: mechanical ventilation group<br>Patient in brain death for whom a multi-organ sampling is planned | Procedure: multi-organ sampling<br>* a diaphragmatic biopsy (100 microgram) will be performed by the surgeon during surgery.<br>|
| Experimental: mechanical ventilation - sepsis group<br>Patient under controlled mechanical ventilation to undergo abdominal or thoracic surgery in a septic context (peritonitis, mediastinitis, pleural abscess) | Procedure: surgery<br>* a diaphragmatic biopsy (100 microgram) and a parietal biopsy will be performed by the surgeon during surgery.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assessment of atrophy of the myofibers of the human diaphragm | Atrophy of the myofibers will be assessed by comparison of the cross sectional area of the three different types of myofibers between the sepsis-mechanical ventilation group and the sepsis group, the ventilation group and the control group | day 0 (day of the surgery) |