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

Proton Magnetic Resonance in Cu(NH_3)_4SO_4・H_2O at Very Low Temperatures

Proton nuclear magnetic resonance in copper tetraminsulphate monohydrate (Cu (NH_3)_4SO_4・H_2O) has been studied in the paramagnetic state, the short range ordered state and the long range ordered state between 0.25°K and 4.2°K. In the paramagnetic and the short range ordered state, normal paramagnetic angular dependences of resonance lines, which have the repetition of 180°, were obtained. At the transition point from the ordinary paramagnetic state to the short range ordered state, no particular change in resonance line was observed. At fairly high magnetic fields (8000～13000 Oe), resonance lines were assigned to protons in NH_3 or in H_2O group, and the positions of the protons in the both groups were estimated. In the temperature region between 4.2°K and 1°K, the extreme separations of N.M.R. signals are nearly proportional to the magnetic susceptibility. Resonance experiments were performed below 1°K by adiabatic demagnetization. A drastic change in the resonance signal was observed at 0.42±0.05°K in bc plane. Below 0.42°K, it seems that the angular dependence of the resonance signal has a repetition of 360°. On the other hand, there is a broad intense resonance line at a frequency of the free proton, which is independent of the direction of the external static field. The shift of the resonance line from the free proton resonance frequency, which is characteristic of the long range ordered state, decreases as a modified Brillouin function with increasing temperature, and disappears at about 0.42°K. By the analysis of resonance lines, it is suggested that Cu^ magnetic moments lie nearly parallel and antiparallel to -O-Cu-O-chains

Effects of intravenous immunoglobulin therapy in Japanese patients with polymyositis and dermatomyositis resistant to corticosteroids : a randomized double-blind placebo-controlled trial

High-dose intravenous immunoglobulin (IVIG) therapy has been effective in treating various autoimmune and systemic inflammatory diseases. Here, we assessed the efficacy and safety of IVIG therapy with polyethylene glycol-treated human IgG (drug code GB-0998) for patients with corticosteroid-refractory polymyositis (PM) and dermatomyositis (DM) by means of a randomized, double-blind, placebo-controlled study. We randomly assigned 26 subjects (16 PM and 10 DM) to receive either GB-0998 or placebo. Intragroup comparison in the GB-0998 group showed statistically significant improvements due to GB-0998 administration in the primary endpoint (manual muscle test score) and secondary endpoints (serum creatine kinase level and activities of daily living score). However, significant improvements were also found in the placebo group, and comparison of the GB-0998 group with the placebo group did not show any significant difference between the groups. We discuss possible reasons for the absence of a clear intergroup difference in efficacy. Nineteen adverse drug reactions were observed in 11 of 26 subjects (42.3%), of which 2 events (decreased muscle strength and increased serum creatine kinase) were assessed as serious; however, they are previously known events. These results indicate that GB-0998 can be safely used with the same precautions as other current IVIG therapy