Circulating adrenomedullin estimates survival and reversibility of organ failure in sepsis: the prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock-1 (AdrenOSS-1) study

Background: Adrenomedullin (ADM) regulates vascular tone and endothelial permeability during sepsis. Levels of circulating biologically active ADM (bio-ADM) show an inverse relationship with blood pressure and a direct relationship with vasopressor requirement. In the present prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock 1 (, AdrenOSS-1) study, we assessed relationships between circulating bio-ADM during the initial intensive care unit (ICU) stay and short-term outcome in order to eventually design a biomarker-guided randomized controlled trial. Methods: AdrenOSS-1 was a prospective observational multinational study. The primary outcome was 28-day mortality. Secondary outcomes included organ failure as defined by Sequential Organ Failure Assessment (SOFA) score, organ support with focus on vasopressor/inotropic use, and need for renal replacement therapy. AdrenOSS-1 included 583 patients admitted to the ICU with sepsis or septic shock. Results: Circulating bio-ADM levels were measured upon admission and at day 2. Median bio-ADM concentration upon admission was 80.5 pg/ml [IQR 41.5-148.1 pg/ml]. Initial SOFA score was 7 [IQR 5-10], and 28-day mortality was 22%. We found marked associations between bio-ADM upon admission and 28-day mortality (unadjusted standardized HR 2.3 [CI 1.9-2.9]; adjusted HR 1.6 [CI 1.1-2.5]) and between bio-ADM levels and SOFA score (p < 0.0001). Need of vasopressor/inotrope, renal replacement therapy, and positive fluid balance were more prevalent in patients with a bio-ADM > 70 pg/ml upon admission than in those with bio-ADM ≤ 70 pg/ml. In patients with bio-ADM > 70 pg/ml upon admission, decrease in bio-ADM below 70 pg/ml at day 2 was associated with recovery of organ function at day 7 and better 28-day outcome (9.5% mortality). By contrast, persistently elevated bio-ADM at day 2 was associated with prolonged organ dysfunction and high 28-day mortality (38.1% mortality, HR 4.9, 95% CI 2.5-9.8). Conclusions: AdrenOSS-1 shows that early levels and rapid changes in bio-ADM estimate short-term outcome in sepsis and septic shock. These data are the backbone of the design of the biomarker-guided AdrenOSS-2 trial. Trial registration: ClinicalTrials.gov, NCT02393781. Registered on March 19, 2015

Circulating adrenomedullin estimates survival and reversibility of organ failure in sepsis: the prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock-1 (AdrenOSS-1) study

BACKGROUND: Adrenomedullin (ADM) regulates vascular tone and endothelial permeability during sepsis. Levels of circulating biologically active ADM (bio-ADM) show an inverse relationship with blood pressure and a direct relationship with vasopressor requirement. In the present prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock 1 (, AdrenOSS-1) study, we assessed relationships between circulating bio-ADM during the initial intensive care unit (ICU) stay and short-term outcome in order to eventually design a biomarker-guided randomized controlled trial. METHODS: AdrenOSS-1 was a prospective observational multinational study. The primary outcome was 28-day mortality. Secondary outcomes included organ failure as defined by Sequential Organ Failure Assessment (SOFA) score, organ support with focus on vasopressor/inotropic use, and need for renal replacement therapy. AdrenOSS-1 included 583 patients admitted to the ICU with sepsis or septic shock. RESULTS: Circulating bio-ADM levels were measured upon admission and at day 2. Median bio-ADM concentration upon admission was 80.5 pg/ml [IQR 41.5-148.1 pg/ml]. Initial SOFA score was 7 [IQR 5-10], and 28-day mortality was 22%. We found marked associations between bio-ADM upon admission and 28-day mortality (unadjusted standardized HR 2.3 [CI 1.9-2.9]; adjusted HR 1.6 [CI 1.1-2.5]) and between bio-ADM levels and SOFA score (p < 0.0001). Need of vasopressor/inotrope, renal replacement therapy, and positive fluid balance were more prevalent in patients with a bio-ADM > 70 pg/ml upon admission than in those with bio-ADM ≤ 70 pg/ml. In patients with bio-ADM > 70 pg/ml upon admission, decrease in bio-ADM below 70 pg/ml at day 2 was associated with recovery of organ function at day 7 and better 28-day outcome (9.5% mortality). By contrast, persistently elevated bio-ADM at day 2 was associated with prolonged organ dysfunction and high 28-day mortality (38.1% mortality, HR 4.9, 95% CI 2.5-9.8). CONCLUSIONS: AdrenOSS-1 shows that early levels and rapid changes in bio-ADM estimate short-term outcome in sepsis and septic shock. These data are the backbone of the design of the biomarker-guided AdrenOSS-2 trial. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02393781 . Registered on March 19, 2015

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Appareillage pour les dépots de couches minces sur support chauffé

In this paper is described an apparatus which allows one to obtain thin films on a heated substrate by a vacuum technique. The author shows the principle of the oven designed in an attempt to obtain a uniform temperature in a several cm3 volume without any variation with time.Cet article décrit un appareillage destiné à la réalisation sous vide de couches minces sur support chauffé. L'auteur s'est attaché plus particulièrement à la réalisation du four permettant d'obtenir une température uniforme à une fraction de degré près dans un volume de plusieurs centimètres cubes et ayant la même stabilisation dans le temps

Résistances et capacité internes d'une photopile au sélénium aux basses températures.

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Quelques considérations sur les amplificateurs électroniques à coefficient d'amplification négatif élevé. Applications aux appareils de mesure

This paper is concerned with D. C. high negative gain feedback electrenic amplifiers. The calculations are made for two typical cases : those of a very small, and of a very high input impedance. In a second part, the case is considered of an input consisting in a light-spot instrument, such as a galvanometer or an electrometer : the effects of such an input on impedance, period and damping are examined. Each case is illustrated by some numerical examples.Nous étudions dans ce travail les amplificateurs électroniques à courant continu et à coefficient d'amplification négatif élevé, dans le cas particulier où une boucle de contre-réaction relie la sortie à l'entrée. Nous ferons les calculs pour deux montages caractéristiques : à impédance d'entrée très faible, ou très élevée. Dans une seconde partie, nous envisagerons le cas où le circuit d'entrée de l'amplificateur est un appareil à spot lumineux, tel que galvanomètre, électromètre, et nous examinerons les répercussions d'un tel montage sur l'impédance d'entrée, la période propre et l'amortissement. Quelques exemples numériques sont joints à chaque cas pour en donner des exemples typiques d'utilisation

Force électromotrice en circuit ouvert d'une photopile au sélénium aux basses températures

The electromotive force in open circuit at low temperatures increases rapidly as the temperature decreases. This variation is approximately proportional to that of the resistance. Our assumptions concerning the internal mechanism of photocells are thus checked and a general expression independent of the photocell size is given. Notwithstanding irregular manufacture making, a good enough quantitative check could be nevertheless obtained.L'étude de la force électromotrice à vide, aux basses températures, montre une augmentation rapide de la f. e. m. lorsque T décroît. Cette variation a été trouvée approximativement proportionnelle à celle de la résistance. Ceci vérifie nos hypothèses sur le fonctionnement interne des photopiles. Nous avons pu trouver une relation générale indépendante des dimensions de la cellule. Les irrégularités de la fabrication industrielle permettent néanmoins une assez bonne vérification quantitative

Les constantes de temps élevées dans les photopiles au sélénium - (Effet de fatigue. — Effet Hamaker-Beezhold. — Effets nouveaux.)

Dans une première partie, purement expérimentale, nous étudions les divers phénomènes à constante de temps élevée (supérieure à la minute), à savoir : les phénomènes de fatigue consécutive à un éclairement intense ou prolongé, l'effet Hamaker-Beezhold pour les éclairements faibles et enfin des effets nouveaux se rattachant à ce dernier. Nous exposons, dans une seconde partie, une théorie liée à la densité d'électrons libres et de trous positifs dans la couche d'arrêt, permettant d'expliquer (qualitativement pour le moment) l'ensemble des phénomènes décrits dans la première partie

Interprétation électronique des phénomènes d'inertie dans les photopiles (en particulier capacité interne)

Le calcul des durées de transit des photoélectrons à travers la couche d'arrêt permet d'expliquer qualitativement les phénomènes d'inertie dès photopiles interprétés jusqu'à présent comme dus à une capacité interne variable. L'hypothèse d'une conductivité de la couche d'arrêt variable avec le nombre d'électrons libres donne ensuite une explication satisfaisante de la résistance interne de la photopile et de ses variations sous certaines influences. A partir de cet ensemble, il est possible de déterminer une constante de temps équivalente pour la photopile et d'en prévoir les variations en fonction des divers paramètres d'utilisation