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

HarmoS Schulsprache: Kompetenzbeschreibungen und Basisstandards

Der folgende Beitrag berichtet von den Arbeiten des Projekts HarmoS Schulsprache, in dem für alle Landessprachen gemeinsame Kompetenzbeschreibungen und Vorschläge für sprachübergreifende Basisstandards für Deutsch, Französisch und Italienisch entwickelt wurden. Wir fokussieren in unserem Beitrag Perspektiven des Projekts, seine Anlage, seine Überlegungen zum Kompetenzmodell und zu Basisstandards sowie den fachdidaktischen Nutzen solcher Projektarbeit. Diese Darstellungen münden abschliessend in die Formulierung von Perspektiven und Konsequenzen für die Lehrerbildung

Editorial. Mündlichkeit: aktuelle Entwicklungen in verschiedenen Kontexten

Die Beiträge insgesamt illustrieren den Reichtum des Forschungsfelds der Mündlichkeit – Linguistik, Psycholinguistik, Soziolinguistik, Didaktik und Kunst sind die Berührungsfelder. Neben den verschiedenen teils eher theoretischen, teils eher praxisbezogenen Orientierungen im breiten Feld der Mündlichkeit befassen sich auch einige Artikel dieser Zeitschriftenausgabe mit methodischen Fragen, beispielsweise damit, welche Indizien oder Kriterien beobachtbar sind, mit denen Schulerfolg festgestellt werden kann. Die beiden französischsprachigen Beiträge interessieren sich zusätzlich für die historische Perspektive des Untersuchungsgegenstands. Es ist zu hoffen, dass beim Lesen der Artikel das Interesse an der Mündlichkeit grundsätzlich geweckt wird und dass die Reflexion über den Stellenwert der Mündlichkeit in Gesellschaft und Schule angeregt werden kann. Fragen gibt es genug: Ist die Mündlichkeit wieder im Vormarsch? Wie beeinflussen die neuen Formen des Schreibens die mündliche und schriftliche Kommunikationspraxis? Kann – denkt man an gewisse Formen des mündlichen Geschichtenerzählens wie Slam oder Rap oder an Events wie Erzählabende oder Poesiefestivals – von einer Renaissance des Mündlichen gesprochen werden? (DIPF/Orig.)L’ensemble de ces textes illustre la richesse du champ de la recherche – linguistique, psycholinguistique, sociolinguistique, didactique, voire artistique (improvisation) – à propos de l’oralité. On soulignera en outre que, au-delà de ces différentes inscriptions dans le champ, au-delà des orientations plutôt théoriques ou plutôt praxéologiques des différents textes, plusieurs des contributions à ce numéro abordent également des questions méthodologiques relatives, par exemple, aux indices observables qui peuvent être exploités en vue d’une évaluation du succès d’un enseignement. Les contributions en français, pour leur part, s’intéressent toutes deux à l’épaisseur historique de leur objet d’étude. Au final, nous espérons que le lecteur aura lui aussi envie de rouvrir ce chantier, de méditer ces réflexions nouvelles à propos de la place de l’oral dans la société actuelle, à propos de la diversité des formes d’oralité et, surtout, des enjeux de l’oralité dans le domaine de l’école et de la formation. Et les questions ne manquent en tout cas pas: ainsi, l’oral est-il en train de «gagner du terrain» par rapport à l’écrit? Ou les formes nouvelles d’écrit sont-elles en train de prendre le dessus? N’y aurait-il pas une certaine recrudescence, voire une véritable «renaissance» de certaines formes d’oralité telles le conte oral ou le slam, en relation avec la vague croissante qu’on observe aujourd’hui de manifestations centrées sur de tels genres (soirées de contes, festivals de poésie…)? (DIPF/Orig.

Éditorial. Oralité: développements actuels dans différents contextes

L’ensemble de ces textes illustre la richesse du champ de la recherche – linguistique, psycholinguistique, sociolinguistique, didactique, voire artistique (improvisation) – à propos de l’oralité. On soulignera en outre que, au-delà de ces différentes inscriptions dans le champ, au-delà des orientations plutôt théoriques ou plutôt praxéologiques des différents textes, plusieurs des contributions à ce numéro abordent également des questions méthodologiques relatives, par exemple, aux indices observables qui peuvent être exploités en vue d’une évaluation du succès d’un enseignement. Les contributions en français, pour leur part, s’intéressent toutes deux à l’épaisseur historique de leur objet d’étude. Au final, nous espérons que le lecteur aura lui aussi envie de rouvrir ce chantier, de méditer ces réflexions nouvelles à propos de la place de l’oral dans la société actuelle, à propos de la diversité des formes d’oralité et, surtout, des enjeux de l’oralité dans le domaine de l’école et de la formation. Et les questions ne manquent en tout cas pas: ainsi, l’oral est-il en train de «gagner du terrain» par rapport à l’écrit? Ou les formes nouvelles d’écrit sont-elles en train de prendre le dessus? N’y aurait-il pas une certaine recrudescence, voire une véritable «renaissance» de certaines formes d’oralité telles le conte oral ou le slam, en relation avec la vague croissante qu’on observe aujourd’hui de manifestations centrées sur de tels genres (soirées de contes, festivals de poésie…)? (DIPF/Orig.)Die Beiträge insgesamt illustrieren den Reichtum des Forschungsfelds der Mündlichkeit – Linguistik, Psycholinguistik, Soziolinguistik, Didaktik und Kunst sind die Berührungsfelder. Neben den verschiedenen teils eher theoretischen, teils eher praxisbezogenen Orientierungen im breiten Feld der Mündlichkeit befassen sich auch einige Artikel dieser Zeitschriftenausgabe mit methodischen Fragen, beispielsweise damit, welche Indizien oder Kriterien beobachtbar sind, mit denen Schulerfolg festgestellt werden kann. Die beiden französischsprachigen Beiträge interessieren sich zusätzlich für die historische Perspektive des Untersuchungsgegenstands. Es ist zu hoffen, dass beim Lesen der Artikel das Interesse an der Mündlichkeit grundsätzlich geweckt wird und dass die Reflexion über den Stellenwert der Mündlichkeit in Gesellschaft und Schule angeregt werden kann. Fragen gibt es genug: Ist die Mündlichkeit wieder im Vormarsch? Wie beeinflussen die neuen Formen des Schreibens die mündliche und schriftliche Kommunikationspraxis? Kann – denkt man an gewisse Formen des mündlichen Geschichtenerzählens wie Slam oder Rap oder an Events wie Erzählabende oder Poesiefestivals – von einer Renaissance des Mündlichen gesprochen werden? (DIPF/Orig.

Immunocompromised patients with acute respiratory distress syndrome : Secondary analysis of the LUNG SAFE database

The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the LUNG SAFE database

Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p &lt; 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p &lt; 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Global Survey of Outcomes of Neurocritical Care Patients: Analysis of the PRINCE Study Part 2

BACKGROUND: Neurocritical care is devoted to the care of critically ill patients with acute neurological or neurosurgical emergencies. There is limited information regarding epidemiological data, disease characteristics, variability of clinical care, and in-hospital mortality of neurocritically ill patients worldwide. We addressed these issues in the Point PRevalence In Neurocritical CarE (PRINCE) study, a prospective, cross-sectional, observational study. METHODS: We recruited patients from various intensive care units (ICUs) admitted on a pre-specified date, and the investigators recorded specific clinical care activities they performed on the subjects during their first 7 days of admission or discharge (whichever came first) from their ICUs and at hospital discharge. In this manuscript, we analyzed the final data set of the study that included patient admission characteristics, disease type and severity, ICU resources, ICU and hospital length of stay, and in-hospital mortality. We present descriptive statistics to summarize data from the case report form. We tested differences between geographically grouped data using parametric and nonparametric testing as appropriate. We used a multivariable logistic regression model to evaluate factors associated with in-hospital mortality. RESULTS: We analyzed data from 1545 patients admitted to 147 participating sites from 31 countries of which most were from North America (69%, N = 1063). Globally, there was variability in patient characteristics, admission diagnosis, ICU treatment team and resource allocation, and in-hospital mortality. Seventy-three percent of the participating centers were academic, and the most common admitting diagnosis was subarachnoid hemorrhage (13%). The majority of patients were male (59%), a half of whom had at least two comorbidities, and median Glasgow Coma Scale (GCS) of 13. Factors associated with in-hospital mortality included age (OR 1.03; 95% CI, 1.02 to 1.04); lower GCS (OR 1.20; 95% CI, 1.14 to 1.16 for every point reduction in GCS); pupillary reactivity (OR 1.8; 95% CI, 1.09 to 3.23 for bilateral unreactive pupils); admission source (emergency room versus direct admission [OR 2.2; 95% CI, 1.3 to 3.75]; admission from a general ward versus direct admission [OR 5.85; 95% CI, 2.75 to 12.45; and admission from another ICU versus direct admission [OR 3.34; 95% CI, 1.27 to 8.8]); and the absence of a dedicated neurocritical care unit (NCCU) (OR 1.7; 95% CI, 1.04 to 2.47). CONCLUSION: PRINCE is the first study to evaluate care patterns of neurocritical patients worldwide. The data suggest that there is a wide variability in clinical care resources and patient characteristics. Neurological severity of illness and the absence of a dedicated NCCU are independent predictors of in-patient mortality.status: publishe