Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

La sécutité sociale en Belgique: défis et perspectives

info:eu-repo/semantics/nonPublishe

Haemodialysis in schizophrenia: a double blind study :preliminary report

The therapeutic effects of haemodialysis were evaluated in schizophrenic patients using a double blind procedure. Twelve patients were diagnosed as acute schizophrenics according to Feighner's criteria for psychopathology. After obtaining informed consent, the patients were randomly assigned to active haemodialysis (AD) or sham dialysis (SD). An 8 days "drug washout period" was followed by AD or SD treatment of 4 weeks (two 5 hours sessions per week) and psychopathological evaluations were performed regularly in a blind fashion using the Brief Psychiatry Rating Scale (BPRS) and the Comprehensive Psychopathological Rating Scale (CPRS). Nine of the 12 patients were improved by both extracorporeal procedures with or without active dialysis. No significant difference appeared however between both groups in the rate and degree of improvement of nuclear symptoms of schizophrenia. Nevertheless, AD was significantly more efficient in relieving affective symptomatology, suggesting the potential involvement of some endogenous dialysable substance (s) in the pathogenesis of mood disturbances in schizophrenia.Clinical TrialJournal ArticleRandomized Controlled Trialinfo:eu-repo/semantics/publishe

Hémodialyse et schizophrénie

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Haemodialysis in schizophrenia.

Clinical TrialComparative StudyLetterRandomized Controlled TrialSCOPUS: le.jinfo:eu-repo/semantics/publishe

Effects of 'jet lag' on hormonal patterns. I. Procedures, variations in total plasma proteins, and disruption of adrenocorticotropin-cortisol periodicity

Five normal male volunteers were submitted to blood sampling at 15-min intervals during seven 24-h periods staggered over 10 weeks while they underwent successively a westward and an eastward 7-h time shift by jet. Total proteins (TPP), ACTH, and cortisol concentrations were measured in each plasma sample. Possible psychological stresses were minimized by careful selection and adjustment of the volunteers before the beginning of the investigation. Physical facilities and time of the year of the execution of the study were chosen in order to avoid the influence of differences in air temperature and duration of daylight. The westward and eastward travels involved, respectively, periods of 23 and 33 h of sleep deprivation without recumbency. TPP levels were measured on each sample in order to monitor plasma dilution. Rapid fluctuations of TPP of an average magnitude of 12% were observed in all studies independently of posture or travel. They did not result from artefactual dilution due to fluid infusion. Seventy percent of the individual 24-h TPP patterns showed significantly higher TPP concentrations during ambulation than during recumbency, and a circadian rhythm with an acrophase during daytime could be detected in 21 of 34 profiles. These data thus generally support the concept of posture dependence of TPP daily variations. Transient disruptions (abolished or reversed differences between ambulation and recumbency TPP levels and/or absence or reversal of circadian rhythm) of the 24-h TPP pattern was observed in 7 of the 9 profiles obtained 1 day after the flights and was more severe after the eastward shift. It is suggested that the prolonged ambulation periods as well as the change in the type of ambulatory activity involved in commercial airline transportation caused the delay in the resumption of the usual circadian pattern of TPP levels. The time of maximal secretion (acrophase) and the quiescent period of the 24-h pattern of ACTH and cortisol adapted differently to the time shifts, suggesting that the various components of the pituitary-adrenal periodicity may be under different controls. Partial shifts of the acrophase toward the new clock time occurred as early as 1 day after travel in both directions, and the synchronization of the acrophase was complete 10 days after both westward and eastward flights. In contrast, the quiescent period needed at least 3 weeks to adapt to Chicago time (alterations consisted of desynchronization and fragmentation) but had returned to normal on the 11th day after arrival in Brussels. 'Jet lag' failed to produce quantitative secretory alterations, since no significant changes were observed in the 24-h mean levels, the amplitude of the circadian rhythms, or the frequency or global magnitude of episodic fluctuations of both hormones. Disruption in the sleep patterns, with an increase in rapid eye movement sleep, and subjective psychological discomfort, rated by Hamilton's anxiety and depression scales, were highly significant after the eastward flight only. In contrast to the persistent disruption in the pituitary-adrenal periodicity, sleep and psychological indexes had returned to normal when recorded 11 days after flight. Although no consistent correlation was found between the disturbances in the pituitary-adrenal periodicity and the level of psychological discomfort, subjects with the highest and lowest scores on the Hamilton scales showed, respectively, the slowest and fastest adaptation of the cortisol acarophase to the new clock time.SCOPUS: ar.jinfo:eu-repo/semantics/publishe