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

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Fatores psicossociais enfrentados por grávidas na fase final da adolescência

Objective: To know the psychosocial factors faced by pregnant adolescents attending a Primary Health Care Center. Methods: Qualitative exploratory and descriptive study carried out using a focus group in December 2015 in a city in Northern Ceará. Participants were eight pregnant women aged 18 to 19 years. Thematic analysis was performed and the following categories emerged: Reasons for getting pregnant and feelings experienced by adolescents; Family and professional support versus prejudice; Positive changes versus difficulties faced. Results: The findings reveal that the reasons for getting pregnant ranged from lack of contraception to believing that they would not get pregnant. In addition, nurses were the most cited professionals regarding the social support network. As for positive changes, closer relationships with the family and partner stood out. With regard to the difficulties faced, these are related to not being able to continue their education. Conclusion: Feelings of rejection, sadness and anguish emerged from an unwanted pregnancy and its huge impact on the psychological well-being of adolescents.Objetivo: Conocer los factores psicosociales afrontados por adolescentes embarazadas asistidas en una Unidad de Atención Primaria de Salud. Métodos: Investigación exploratoria y descriptiva de abordaje cualitativo realizada a través de grupo focal en diciembre de 2015 en una ciudad de la zona norte del estado de Ceará. Ocho embarazadas con edad entre 18 y 19 años participaron del estudio. El análisis se dio por temática con las siguientes categorías: Razones para quedarse embarazada y sentimientos vividos por las adolescentes; Apoyo familiar y profesional versus prejuicio; Cambios positivos versus dificultades afrontadas. Resultados: Los hallazgos desvelan que las razones para el embarazo variaron desde la falta de contracepción hasta la confianza de que no iban a quedarse embarazadas. Además, respecto la red de apoyo social, los enfermeros fueron los profesionales más citados. Sobre los cambios positivos, se evidenció mayor cercanía de la familia y de la pareja; respecto las dificultades afrontadas estas se refieren al no seguimiento de los estudios. Conclusión: Emergieron sentimientos de rechazo, tristeza y angustia oriundos de un embarazo no deseado y a su gran impacto en la vida psicológica de las adolescentes.Objetivo: Conhecer os fatores psicossociais enfrentados por adolescentes grávidas atendidas em uma Unidade de Atenção Primária à Saúde. Métodos: Pesquisa exploratória e descritiva, com abordagem qualitativa, realizada através de grupo focal, em dezembro de 2015, em uma cidade da zona Norte do estado do Ceará. Participaram deste estudo oito gestantes com idade entre 18 e 19 anos. A análise apresentou-se, na modalidade temática, com as seguintes categorias: Razões para engravidar e sentimentos vivenciados pelas adolescentes; Apoio familiar e profissional versus preconceito; Mudanças positivas versus dificuldades enfrentadas. Resultados: Os achados desvelam que as razões da ocorrência da gravidez variaram desde a falta de contracepção até a confiança de que não iriam engravidar. Além disso, no que tange à rede de apoio social, os enfermeiros foram os profissionais mais citados. Quanto às mudanças positivas, evidenciaram maior aproximação da família e do companheiro; já as dificuldades enfrentadas são referentes a não conseguir manter os estudos. Conclusão: Emergiram sentimentos de rejeição, tristeza e angústia oriundos de uma gravidez indesejada e ao grande impacto na vida psicológica das adolescentes

Joint Ultrasonography of Goats Infected by the Caprine Arthritis Encephalitis Virus

Background: The most important form of caprine arthritis encephalitis virus in the goat is the arthritic, generally observed in animals over eight months of age. Differently in sheep, there is less arthritis incidence, affecting 2-3-year-old animals. The clinical alterations frequently affect goat joints, and an increase in the joint consistency and size is observed. The objective of the present study was to standardize the ultrasound technique to access joints in animals infected with the caprine arthritis encephalitis virus (CAEV), so that it can be a complimentary support tool for diagnosis and animal management.Materials, Methods &amp; Results: Animals were examined from farms located in the municipality of Teresina, state of Piauí, Brazil. For this, the M-Turbo, Sonosite Fujifilm ultrasonography apparatus was used, attached to a linear transducer with 10-13 MHz frequency. The ultrasound examination analyzed three regions: patella-humerus joint, carpal and tarsal joints. The patella-humerus joint was characterized by its concave convex surface. The surface of the head humerus was a fine hyperechoic line composed by the junction between the joint cartilage and the subcontinent bone. The sub patella muscle was visible and its fibers present a parallel and hypoechogenic pattern compared to bone tissue. A discreet muscle edge with echogenicity was observed separating the sub patella and supraspinatus muscles. The surface of the proximal and distal rows of the carpal bones was characterized by fine hyperechogenic lines that formed acoustic shadow. Regarding the bones of the tarsal joint, the surface of the central tarsal joint bone was observed centrally as a fine, hyperechogenic line. The third tarsal joint bone was visualized on the left side and was represented by a thick hyperechoic line, while the fourth tarsal joint bone was observed to the right with a hypoechogenic surface and both formed acoustic shadow.Discussion: Joint inflammation caused by other diseases, such as derived from bacteria of the Micoplasma genus can suggest similar semiological aspects and can present positive results for the joint clinical index. Studies carried out have established measurements of the joints of animals affected by various degrees of arthritis, where absolute values equal or less than 5.5 cm would be indicative of negative arthritis diagnosis, variations between 6.0 and 6.5 cm would be considered suspicious and when equal or greater than 7.0 cm they would be positive. From the anatomical point of view, ultrasound assessment of the joints of the normal animals showed a morphological pattern as observed in dogs, horses and humans. The loss of echogenicity, surface erosions and exposure of subchondral bone observed in goats infected with CAEV were also reported in dogs with patella-humerus osteochondrosis, by the presence of a cartilage flap seen radiographically, or even as cracks, characterized by a hyperechoic line parallel to the subchondral defect, in the ultrasonography examination. The lesions observed in the ultrasound examination showed various degrees of osteoarthritis, with the presence of sound hyperreflection, hyperechogenic areas, cartilage lesions with erosion of the subchondral bone and loss of anatomic limits, and these characteristics were described for the metacarpal phalangeal and metatarsal phalangeal joints of dogs submitted to routine radiographic examination. The ultrasound examination of the joints of normal goats and goats infected with caprine arthritis encephalitis virus allowed the comparative description of normal anatomy, evolution of joint and adjacent soft tissue lesions, generating valuable clinical and surgical information

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

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