120 research outputs found
Quality of life in elderly ICU survivors before the COVID-19 pandemic: a systematic review and meta-analysis of cohort studies
Objectives The influence of age on intensive care unit
(ICU) decision-making
is complex, and it is unclear if
it is based on expected subjective or objective patient
outcomes. To address recent concerns over age-based
ICU
decision-making,
we explored patient-assessed
quality of
life (QoL) in ICU survivors before the COVID-19
pandemic.
Design A systematic review and meta-analysis
of cohort
studies published between January 2000 and April 2020,
of elderly patients admitted to ICUs.
Primary and secondary outcome measures We
extracted data on self-reported
QoL (EQ-5D
composite
score), demographic and clinical variables. Using a
random-effect
meta-analysis,
we then compared QoL
scores at follow-up
to scores either before admission, age-matched
population controls or younger ICU survivors. We
conducted sensitivity analyses to study heterogeneity and
bias and a qualitative synthesis of subscores.
Results We identified 2536 studies and included 22 for
qualitative synthesis and 18 for meta-analysis
(n=2326
elderly survivors). Elderly survivors’ QoL was significantly
worse than younger ICU survivors, with a small-to-
medium
effect size (d=0.35 (−0.53 and −0.16)). Elderly survivors’
QoL was also significantly greater when measured slightly
before ICU, compared with follow-up,
with a small effect
size (d=0.26 (−0.44 and −0.08)). Finally, their QoL was
also marginally significantly worse than age-matched
community controls, also with a small effect size (d=0.21
(−0.43 and 0.00)). Mortality rates and length of follow-up
partly explained heterogeneity. Reductions in QoL seemed
primarily due to physical health, rather than mental health
items.
Conclusions The results suggest that the proportionality
of age as a determinant of ICU resource allocation should
be kept under close review and that subjective QoL
outcomes should inform person-centred
decision -aking in
elderly ICU patients.
PROSPERO registration number CRD42020181181
Population expansion of the invasive Pomacentridae Chromis limbata (Valenciennes, 1833) in Southern Brazilian coast: long-term monitoring, fundamental niche availability and new records
Human-mediated species invasions are recognized as a leading cause of global biotic homogenization and extinction. Studies on colonization events since early stages, establishment of new populations and range extension are scarce because of their rarity, difficult detection and monitoring. Chromis limbata is a reef-associated and non-migratory marine fish from the family Pomacentridae found in depths ranging between 3 and 45 m. The original distribution of the species encompassed exclusively the eastern Atlantic, including the Azores, Madeira and the Canary Islands. It is also commonly reported from West Africa between Senegal and Pointe Noire, Congo. In 2008, vagrant individuals of C. limbata were recorded off the east coast of Santa Catarina Island, South Brazil (27° 41' 44″ S, 48° 27' 53″ W). This study evaluated the increasing densities of C. limbata populations in Santa Catarina State shoreline. Two recent expansions, northwards to São Paulo State and southwards to Rio Grande do Sul State, are discussed, and a niche model of maximum entropy (MaxEnt) was performed to evaluate suitable C. limbata habitats. Brazilian populations are established and significantly increasing in most sites where the species has been detected. The distributional boundaries predicted by the model are clearly wider than their known range of occurrence, evidencing environmental suitability in both hemispheres from areas where the species still does not occur. Ecological processes such as competition, predation and specially habitat selectivity may regulate their populations and overall distribution range. A long-term monitoring programme and population genetics studies are necessary for a better understanding of this invasion and its consequences to natural communities.CNPq, Grant/Award Number: CNPq 475367/2006-5; ECOPERE-SE Project; FAPES, Grant/Award Number: PROFIX program No 10/2018 -T.O.: 348/2018; FAPESC, Grant/Award Number: Biodiversidade Marinha do Estado de Santa Catarina Project PI: A.L. FAPESC 4302/2010-8; FAPESC/CNPq, Grant/Award Number: SISBIOTA-Mar project PI: S.R.F. CNPq 563276/2010-0; FAPESC 6308/2011-8; Petrobras (BR), Grant/Award Number: MAArE Project; King Abdullah University of Science and Technology; Coordenação de Aperfeiçoamento de Pessoal de Nível Superiorinfo:eu-repo/semantics/publishedVersio
A revision of the status of Lepadogaster lepadogaster (Teleostei : Gobiesocidae): sympatric subspecies or a long misunderstood blend of species?
Molecular (partial mitochondrial 12S ribosomal DNA sequences), morphological and meristic analysis of Lepadogaster lepadogaster lepadogaster, L. l. purpurea and L. zebrina were performed to investigate the relationships between these taxa. On the western shore of mainland Portugal, where the two subspecies of L. lepadogaster occur sympatrically, they differ in microhabitat preferences and their breeding seasons are largely out of phase. This information, combined with data on distribution patterns, led to the following conclusions: Lepadogaster l. purpurea is considered to be a valid species, L. purpurea (Bonnaterre, 1788), different from L. l. lepadogaster, now designated L. lepadogaster (Bonnaterre, 1788). L. zebrina was found to be a synonym of L. lepadogaster. The two newly defined species were found to be in sympatry at Madeira and the Canary islands, the Atlantic coast of the Iberian Peninsula, and the Mediterranean at least as far as Genoa (Italy). Diagnostic characters and a list of synonyms are provided. (C) 2002 The Linnean Society of London, Biological Journal of the Linnean Society, 2002, 76, 327-338
Opeatogenys gracilis (Pisces: Gobiesocidae): An overlooked species or another ‘Mediterranean endemism’ found in Atlantic waters?
The occurrence of Opeatogenys gracilis outside the Mediterranean Sea is confirmed for the first
time. This is probably a more common species than previously thought, but its apparent
complete dependence on seagrass beds suggests the possibility of including it in the IUCN
threatened species list. Some sex differences are described and a complete meristic and morphometric
description of the species is presented. The occurrence of the species in the north-east
Atlantic indicates that it might be a recent dispersal from the Mediterranean Sea, or an
overlooked part of the autochthonous fauna
Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies
Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p<0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p<0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding
Spontaneous Breathing in Early Acute Respiratory Distress Syndrome: Insights From the Large Observational Study to UNderstand the Global Impact of Severe Acute Respiratory FailurE Study
OBJECTIVES: To describe the characteristics and outcomes of patients with acute respiratory distress syndrome with or without spontaneous breathing and to investigate whether the effects of spontaneous breathing on outcome depend on acute respiratory distress syndrome severity. DESIGN: Planned secondary analysis of a prospective, observational, multicentre cohort study. SETTING: International sample of 459 ICUs from 50 countries. PATIENTS: Patients with acute respiratory distress syndrome and at least 2 days of invasive mechanical ventilation and available data for the mode of mechanical ventilation and respiratory rate for the 2 first days. INTERVENTIONS: Analysis of patients with and without spontaneous breathing, defined by the mode of mechanical ventilation and by actual respiratory rate compared with set respiratory rate during the first 48 hours of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: Spontaneous breathing was present in 67% of patients with mild acute respiratory distress syndrome, 58% of patients with moderate acute respiratory distress syndrome, and 46% of patients with severe acute respiratory distress syndrome. Patients with spontaneous breathing were older and had lower acute respiratory distress syndrome severity, Sequential Organ Failure Assessment scores, ICU and hospital mortality, and were less likely to be diagnosed with acute respiratory distress syndrome by clinicians. In adjusted analysis, spontaneous breathing during the first 2 days was not associated with an effect on ICU or hospital mortality (33% vs 37%; odds ratio, 1.18 [0.92-1.51]; p = 0.19 and 37% vs 41%; odds ratio, 1.18 [0.93-1.50]; p = 0.196, respectively ). Spontaneous breathing was associated with increased ventilator-free days (13 [0-22] vs 8 [0-20]; p = 0.014) and shorter duration of ICU stay (11 [6-20] vs 12 [7-22]; p = 0.04). CONCLUSIONS: Spontaneous breathing is common in patients with acute respiratory distress syndrome during the first 48 hours of mechanical ventilation. Spontaneous breathing is not associated with worse outcomes and may hasten liberation from the ventilator and from ICU. Although these results support the use of spontaneous breathing in patients with acute respiratory distress syndrome independent of acute respiratory distress syndrome severity, the use of controlled ventilation indicates a bias toward use in patients with higher disease severity. In addition, because the lack of reliable data on inspiratory effort in our study, prospective studies incorporating the magnitude of inspiratory effort and adjusting for all potential severity confounders are required
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
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