Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Participatory Culture : How Social Media Active Journalists Make Use of the Medium

As new platforms are developed for communicating, the everyday lives of many are changedat the grounds. The aim with this study was to map the changes in routines when it comes tojournalists making news and communicating with their readers, audience and sources after theintroduction of social media in their work process. By making a qualitative study analyzinglogbooks and interviews of a handful of responding journalists I tried to find what thethoughts were behind the routines of the journalistic work process and why and how they’vechanged. The most obvious change this research has found was that the speed of today’s flowof information has made an impact on both how the respondents gather information andregard their sources. My research is in many ways complimentary to earlier research madewith the same starting point but the findings are a bit different. While my research shows thatthe dialog between producer and consumer is increasing and is sought after, other studies havefailed to make this conclusion

Gilla oss! : En studie av fyra svenska medieföretags arbete med sociala medier

This dissertation contains an exploratory study of how four Swedish media companies has decided to use social media in their daily work, and also how they in fact use them. What are the goals with implementing social media, how do they differ between different companies and do the goals transfer into the newsrooms? The four companies studied are Sveriges Radio, Aftonbladet, Dalarnas Tidningar and Gotlands Media. Media companies that differ from one another both in size, geographical coverage and economy. They range from small local newspapers to national public service radio and the biggest tabloid on the Swedish market. The methods used are qualitative research interviews and field studies as well as quantitative data analysis. The theoretical chapter helps define traditional journalism and journalistic practice. The concepts of boundaries, participatory cultures and normalizing of work methods are also discussed and helps build a context for the analysis of the empirical data. Some key findings from the study are that there are more similarities than differences between the various companies in both how they aim to use social media and how they in fact use them. That the digital development in the surrounding society are much faster than the implementation of new technologies in the newsrooms. Also, that there are differences between how the companies aim to use social media and the actual usage. For instance, all companies strive for a more active dialog with the audience in their visionary work, but has a hard time turning this into reality. There is also notable that social media in this study do not change the journalistic fundamental routines and traditions. The studied journalists are still in control of their own content and they aim to meet the same standard in journalistic quality when working in social media. It is also evident that Facebook is invaluable for all the studied companies, which gives Facebook an interesting indirect power over the journalistic work process and product. Finally, the study finds that it is hard to engage the audience in an active collaboration even when working with social media

Ventilation and Lung Volume During Sleep and in Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) appears to affect up to 5% of the population. The extent to what pulmonary function awake and during sleep relates to obstructive breathing and hypoxemia during sleep in these patients is unclear. The aim of this study was to investigate respiratory function in patients with varying degree of snoring and OSA and to analyse regional lung aeration during sleep. In all, 35 healthy subjects and 90 patients with snoring and OSA were studied. The ventilatory response to CO2 (VRCO2) was measured. Lung function tests were performed. A technique based on computed tomography was developed to study lung aeration during sleep. Patients with OSA displayed a higher VRCO2 in comparison to healthy subjects and snorers (p&lt;0.01). Increased closing volume and reduced expiratory reserve volume (ERV) were found in patients with OSA (p&lt;0.001). In a multiple regression analysis, ERV was an independent predictor of nocturnal apnea (R2=0.13; p=0.001) and desaturation frequency (R2=0.11; p&lt;0.01). In both healthy subjects and OSA patients, lung aeration was reduced during sleep by 0.10 ml gas/g tissue in the dorsal lung region (p&lt;0.05 and p&lt;0.01). OSA patients had a significantly lower gas/tissue ratio in comparison to healthy subjects both awake (-23%; p&lt;0.04) and during sleep (-25%; p&lt;0.04). In a univariate analysis, functional residual capacity (FRC) correlated with the change in lung aeration from wakefulness to sleep (r=-0.78; p&lt;0.001). In patients with OSA, ERV (r=-0.69; p&lt;0.05) and sleep time (r=0.69; p&lt;0.05) correlated with the fall in lung aeration. In conclusion, patients with OSA display an increased ventilatory response to CO2, reduced ERV and increased closing volume. ERV predicts nocturnal apnea and desaturation frequency to a similar extent as obesity. Lung aeration is reduced in the dorsal region during sleep and patients with OSA display a lower amount of gas in comparison to healthy subjects. Decrease in lung volumes, promoting airway closure, and loss of muscle tone contributed to the altered lung function during sleep

Social media in the professional work of Polish, Russian and Swedish journalists

Professional journalistic culture is a complex of journalistic values, practices, norms and media products. On the one hand it tends to unification across the globe, but on the other hand these cultures varies according to cultural diversities.  Technological development leads to a media convergence, increasing interactivity and plenty of opportunities for individualization of media content influence audience’s demands and consequently challenge of traditional routine of journalists’ work, affect professional practices and even undermine traditional role of a journalist in society. Social media creates new conditions for both actors: readers/viewers/listeners and for media professionals who use it as a tool for media work.  Journalists in the different countries, however, use social media for professional needs not equally. This paper is discussing differences and similarities in the patterns of social media use by Polish, Russian and Swedish journalists.  The research is based on a survey of 500 journalists in each country.  Journalism in chang

Social media in the professional work of Polish, Russian and Swedish journalists

Professional journalistic culture is a complex of journalistic values, practices, norms and media products. On the one hand it tends to unification across the globe, but on the other hand these cultures varies according to cultural diversities.  Technological development leads to a media convergence, increasing interactivity and plenty of opportunities for individualization of media content influence audience’s demands and consequently challenge of traditional routine of journalists’ work, affect professional practices and even undermine traditional role of a journalist in society. Social media creates new conditions for both actors: readers/viewers/listeners and for media professionals who use it as a tool for media work.  Journalists in the different countries, however, use social media for professional needs not equally. This paper is discussing differences and similarities in the patterns of social media use by Polish, Russian and Swedish journalists.  The research is based on a survey of 500 journalists in each country. 

Relationship between 24- hour Holter variables, chest discomfort and syncope: Does age matter?

One hundred and forty four ambulatory, non-emergent human subjects from 20-88 years of age were investigated following routine 24 hour Holter monitoring referred by primary and tertiary care centers primarily for evaluation of palpitations and syncope. The patients were grouped into 3 different age categories: A) 20-59 years of age (16%), B) 60-69 years of age (26.4%) and C) > 70 years of age (57.6%). Heart rate profile, RR intervals, symptoms, frequency of premature supra ventricular and ventricular complexes were registered. The data show that though the occurrence and frequency of premature atrial and ventricular contractions over a period of 24 hours did not differ between the groups, the younger subjects documented more subjective discomforts during the Holter monitoring. Extra-systoles in excess of 1000 beats / 24 hour occured incessantly throughout the registration. Patients with syncope and those without did not differ as regards the Holter variables. However, subjects with atrial fibrillation had acceptable rate control and had significantly lower incidence of syncope than those with sinus rhythm. The findings suggest that in a county setting, Holter monitoring for evaluation of syncope may not be the first hand mode of investigation in a non emergent setting. On the contrary, the modality appears to be valuable for monitoring patients with atrial fibrillation. Even mild symptoms in the elderly population may warrant closer clinical follow up to prevent cardiac events and/or syncope leading to serious physical injury

Lung aeration during sleep

BACKGROUND: During sleep, ventilation and functional residual capacity (FRC) decrease slightly. This study addresses regional lung aeration during wakefulness and sleep. METHODS: Ten healthy subjects underwent spirometry awake and with polysomnography, including pulse oximetry, and also CT when awake and during sleep. Lung aeration in different lung regions was analyzed. Another three subjects were studied awake to develop a protocol for dynamic CT scanning during breathing. RESULTS: Aeration in the dorsal, dependent lung region decreased from a mean of 1.14 +/- 0.34 mL (+/- SD) of gas per gram of lung tissue during wakefulness to 1.04 +/- 0.29 mL/g during non-rapid eye movement (NREM) sleep (- 9%) [p = 0.034]. In contrast, aeration increased in the most ventral, nondependent lung region, from 3.52 +/- 0.77 to 3.73 +/- 0.83 mL/g (+ 6%) [p = 0.007]. In one subject studied during rapid eye movement (REM) sleep, aeration decreased from 0.84 to 0.65 mL/g (- 23%). The fall in dorsal lung aeration during sleep correlated to awake FRC (R(2) = 0.60; p = 0.008). Airway closure, measured awake, occurred near and sometimes above the FRC level. Ventilation tended to be larger in dependent, dorsal lung regions, both awake and during sleep (upper region vs lower region, 3.8% vs 4.9% awake, p = 0.16, and 4.5% vs 5.5% asleep, p = 0.09, respectively). CONCLUSIONS: Aeration is reduced in dependent lung regions and increased in ventral regions during NREM and REM sleep. Ventilation was more uniformly distributed between upper and lower lung regions than has previously been reported in awake, upright subjects. Reduced respiratory muscle tone and airway closure are likely causative factors

Feasibility and Effects of Touch Massage and Nurse Led Sleep Counselling in the Treatment of Primary Insomnia

Cognitive Behavioral Therapy (CBT) is basically the only evidence based treatment both in short- as well as long term treatment of insomnia. Previous studies suggest that massage may have a role in initiating sleep and relaxation. This pilot study investigated the feasibility and effects of tactile massage (TM) and nurse led sleep counselling (SC) in the treatment of primary insomnia. Method: Thirty women with primary insomnia were randomized into three different groups: TM, SC or ‘care as usual’ (CAU) followed by a six weeks intervention period. Sleep quality was assessed with sleep diary and polysomnography. The results show that it is feasible to treat primary insomnia with TM. ‘Within’ group analysis showed that the TM group experienced significant improvements in measures of subjective sleep, SC and CAU had no improvements. No significant differences were found in the ‘between’ group analysis. Conclusion: On the basis of the findings, we can conclude that it is feasible to use the methods of TM and SC in the treatment of primary insomnia. Especially TM shows preliminary improvements in subjective measures of sleep, results which needs confirmation in full scale research. Based on the observed effects the research protocol/design is recommended to be simplified and also to combine TM and SC as intervention in future studies

Voluntary apnea evokes diving responses in obstructive sleep apnea patients

Two potentially protective responses to apnea were studied in obstructive sleep apnea (OSA) patients; the diving response and the increase in Hb concentration [Hb] via spleen contraction. Eight OSA patients and ten healthy controls performed apneas in air (A) and apneas with facial immersion in 15 A degrees C water (FIA) after inspiration and without prior hyperventilation. In each condition, subjects performed three apneas of maximal voluntary duration spaced by 2 min of rest. Cardiorespiratory parameters were measured non-invasively, and venous blood samples for [Hb] analysis were drawn before and after apneas. Mean (SD) apnea durations were similar between groups (NS). In controls, the heart rate (HR) reduction was 10 +/- A 10 % at apnea and 19 +/- A 10 % in FIA (P &lt; 0.05). In OSA patients, however, the fall in HR was the same in both conditions, 13 +/- A 10 and 14 +/- A 8 % for A and FIA, respectively (NS). In controls, the [Hb] increase was the same in A and FIA (2.2 +/- A 2.9 and 2.1 +/- A 2.2 %), while in OSA the [Hb] increase was greater during FIA compared to A (3.3 +/- A 2.2 and 1.4 +/- A 0.9 %; P &lt; 0.05). Apnea induces a diving response and [Hb] increase in both groups. OSA patients did not show the typical training effect of the diving response seen in apnea divers despite their frequent nocturnal apneas. However, they also deviated from normal controls in response pattern; face immersion enhanced the cardiovascular diving response in controls but not in OSA, while the hematological response was enhanced by face immersion only in OSA patients