Passive leg raising can predict fluid responsiveness in patients placed on venovenous extracorporeal membrane oxygenation

International audienceABSTRACT: INTRODUCTION: In ICUs, fluid administration is frequently used to treat hypovolaemia. Because volume expansion (VE) can worsen acute respiratory distress syndrome (ARDS) and volume overload must be avoided, predictive indicators of fluid responsiveness are needed. The purpose of this study was to determine whether passive leg raising (PLR) can be used to predict fluid responsiveness in patients with ARDS treated with venovenous extracorporeal membrane oxygenation (ECMO). METHODS: We carried out a prospective study in a university hospital surgical ICU. All patients with ARDS treated with venovenous ECMO and exhibiting clinical and laboratory signs of hypovolaemia were enrolled. We measured PLR-induced changes in stroke volume (ΔPLRSV) and cardiac output (ΔPLRCO) using transthoracic echocardiography. We also assessed PLR-induced changes in ECMO pump flow (ΔPLRPO) and PLR-induced changes in ECMO pulse pressure (ΔPLRPP) as predictors of fluid responsiveness. Responders were defined by an increase in stroke volume (SV) > 15% after VE. RESULTS: Twenty-five measurements were obtained from seventeen patients. In 52% of the measurements (n = 13), SV increased by > 15% after VE (responders). The patients' clinical characteristics appeared to be similar between responders and nonresponders. In the responder group, PLR significantly increased SV, cardiac output and pump flow (P 10% ΔPLRSV may predict fluid responsiveness. ΔPLRPP and ΔPLRPO cannot predict fluid responsiveness

Molecular Systematics of the Deep-Sea Hydrothermal Vent Endemic Brachyuran Family Bythograeidae: A Comparison of Three Bayesian Species Tree Methods

Brachyuran crabs of the family Bythograeidae are endemic to deep-sea hydrothermal vents and represent one of the most successful groups of macroinvertebrates that have colonized this extreme environment. Occurring worldwide, the family includes six genera (Allograea, Austinograea, Bythograea, Cyanagraea, Gandalfus, and Segonzacia) and fourteen formally described species. To investigate their evolutionary relationships, we conducted Maximum Likelihood and Bayesian molecular phylogenetic analyses, based on DNA sequences from fragments of three mitochondrial genes (16S rDNA, Cytochrome oxidase I, and Cytochrome b) and three nuclear genes (28S rDNA, the sodium–potassium ATPase a-subunit ‘NaK’, and Histone H3A). We employed traditional concatenated (i.e., supermatrix) phylogenetic methods, as well as three recently developed Bayesian multilocus methods aimed at inferring species trees from potentially discordant gene trees. We found strong support for two main clades within Bythograeidae: one comprising the members of the genus Bythograea; and the other comprising the remaining genera. Relationships within each of these two clades were partially resolved. We compare our results with an earlier hypothesis on the phylogenetic relationships among bythograeid genera based on morphology. We also discuss the biogeography of the family in the light of our results. Our species tree analyses reveal differences in how each of the three methods weighs conflicting phylogenetic signal from different gene partitions and how limits on the number of outgroup taxa may affect the results

SNO KARST: a French network of observatories for the multidisciplinary study of critical zone processes in karst watersheds and aquifers

Karst aquifers and watersheds represent a major source of drinking water around the world. They are also known as complex and often highly vulnerable hydrosystems due to strong surface groundwater interactions. Improving the understanding of karst functioning is thus a major issue for an efficient management of karst groundwater resources. A comprehensive understanding of the various processes can be achieved only by studying karst systems over a wide range of spatio-temporal scales under different geological, geomorphological, climatic and soil cover settings. The objective of the French Karst National Observatory Service (SNO Karst) is to supply the international scientific community with appropriate data and tools, with the ambition of i) facilitating the collection of long-term observations of hydro-geo-chemical variables in karst, and ii) promoting knowledge-sharing and developing cross-disciplinary research on karst. The present paper provides an overview of the monitoring sites and of collective achievements such as the KarstMod modular modelling platform and the PaPRIKa toolbox. It also presents the research questions addressed within the framework of SNO Karst, along with major research results regarding i) the hydrological response of karst to climate and anthropogenic changes, ii) the influence of karst on geochemical balance of watersheds in the critical zone, and iii) the relationships between the structure and hydrological functioning of karst aquifers and watersheds

Overview of the current use of levosimendan in France: a prospective observational cohort study

Abstract Background Following the results of randomized controlled trials on levosimendan, French health authorities requested an update of the current use and side-effects of this medication on a national scale. Method The France-LEVO registry was a prospective observational cohort study reflecting the indications, dosing regimens, and side-effects of levosimendan, as well as patient outcomes over a year. Results The patients included ( n = 602) represented 29.6% of the national yearly use of levosimendan in France. They were treated for cardiogenic shock ( n = 250, 41.5%), decompensated heart failure ( n = 127, 21.1%), cardiac surgery-related low cardiac output prophylaxis and/or treatment ( n = 86, 14.3%), and weaning from veno-arterial extracorporeal membrane oxygenation ( n = 82, 13.6%). They received 0.18 ± 0.07 µg/kg/min levosimendan over 26 ± 8 h. An initial bolus was administered in 45 patients (7.5%), 103 (17.1%) received repeated infusions, and 461 (76.6%) received inotropes and or vasoactive agents concomitantly. Hypotension was reported in 218 patients (36.2%), atrial fibrillation in 85 (14.1%), and serious adverse events in 17 (2.8%). 136 patients (22.6%) died in hospital, and 26 (4.3%) during the 90-day follow-up. Conclusions We observed that levosimendan was used in accordance with recent recommendations by French physicians. Hypotension and atrial fibrillation remained the most frequent side-effects, while serious adverse event potentially attributable to levosimendan were infrequent. The results suggest that this medication was safe and potentially associated with some benefit in the population studied

Linear advection modelling: the issue of divergent flows

Schemes for linear advection modelling in multiple dimensions on structured grids use either time-splitting or an unsplit approach for flux computation. In the case of strongly divergent flows, time-splitting introduces anisotropy in the solution whereas, with the unsplit approach, more mass than actually available may be abstracted from the computational cells, leading for instance to oscillations and sometimes instability. A simple correction for the flux, taking into account the divergence of the flow, is proposed to eliminate the problem for the unsplit approach. This correction introduces a limitation on the computational time step. An experiment carried out using a market-available software package shows that the problem above is of practical interest, and that verification procedures of modelling software should take into account simulations under non-uniform flows

Riemann solvers for water hammer simulations by Godunov method

The water hammer phenomenon can be described by a 2×2 system of hyperbolic partial differential equations (PDEs). Numerical solution of these PDEs using finite-volume schemes is investigated herein. The underlying concept of the Godunov scheme is the Riemann problem, that must be solved to provide fluxes between the computational cells. The presence of the kinetic terms in the momentum equation determines the existence of shock and rarefaction waves, which influence the design of the Riemann solver. Approximation of the expressions for the Riemann invariants and jump relationships can be used to derive first- and second-order approximate, non-iterative solvers. The first-order approximate solver is almost 2000 times faster than the exact one, but gives inaccurate predictions when the densities and celerities are low. The second-order approximate solver gives very accurate solutions, and is 300 times faster than the exact, iterative one. Detailed indications are provided in the appendices for the practical implementation of the Riemann solvers described herein

Modélisation mécaniste du devenir des produits phytosanitaires dans l'environnement souterrain : application à la protection des captages en aquifère

L'utilisation par les agriculteurs de fertilisants et de produits phytosanitairesentraîne un risque de contamination de la ressource en eau. Ce risque, joint aux exigences de qualité de cette dernière, a pour effet un accroissement de son coût et sa fragilisation. Le souci de concilier l'emploi des produits de protection des cultures et la qualité de la ressource en eau a conduit en particulier à l'élaboration du projet EUREKA ISMAP, dont l'objectif est la réalisation d'un système- d'information et d'aide à la décision pour la gestion des pollutions diffuses d'origine agricole . Dans ce système, la composante "modélisation" est appelée à jouer un rôle important. Les travaux présentés dans ce mémoire entrent dans le cadre de cette composante: le but de cette thèse est la conception et l'application à un site-test d'une méthodologie d'utilisation des outils de simulation des transferts en milieu souterrain de l'eau et des contaminants, afin de déterminer les quantités maximales de produits phytosanitaires pouvant être épandues à la surface du sol, sans pour autant risquer de contaminer les captages en aquifère.Pas de résum

Modelling using stochastic, finite state cellular automata: rule inference from continuum models

A methodology is presented, that allows the simulation time step to be included in the transition rules of stochastic, finite-state cellular automata (CA) models. It is shown that the transition probability should incorporate an exponentially decreasing function of the simulation time step. It is also possible to deduce the transition rules from the parameters of classical, ordinary differential equations. The method is demonstrated by applications to first-order linear kinetics and to the Lotka–Volterra (LV) equations that describe prey–predator interactions. The simulation results from the CA models are shown to be in close agreement with those of the continuum-based models, provided the number of individuals in the CA model is sufficient. Such a `sufficient number' may be highly dependent on the nature of the phenomena to be modelled, with at least 5×104 individuals needed to approximate correctly the LV equations