Inhaled furosemide for relief of air hunger versus sense of breathing effort: a randomized controlled trial

Background. Inhaled furosemide offers a potentially novel treatment for dyspnoea, which may reflect modulation of pulmonary stretch receptor feedback to the brain. Specificity of relief is unclear because different neural pathways may account for different components of clinical dyspnoea. Our objective was to evaluate if inhaled furosemide relieves the air hunger component (uncomfortable urge to breathe) but not the sense of breathing work/effort of dyspnoea. Methods. A randomised, double blind, placebo-controlled crossover trial in 16 healthy volunteers studied in a university research laboratory. Each participant received 3 mist inhalations (either 40 mg furosemide or 4 ml saline) separated by 30–60 min on 2 test days. Each participant was randomised to mist order ‘furosemide-saline-furosemide’ (n- = 8) or ‘saline-furosemide-saline’ (n = 8) on both days. One day involved hypercapnic air hunger tests (mean ± SD PCO2 = 50 ± 3.7 mmHg; constrained ventilation = 9 ± 1.5 L/min), the other involved work/effort tests with targeted ventilation (17 ± 3.1 L/min) and external resistive load (20cmH2O/L/s). Primary outcome was ratings of air hunger or work/effort every 15 s on a visual analogue scale. During saline inhalations, 1.5 mg furosemide was infused intravenously to match the expected systemic absorption from the lungs when furosemide is inhaled. Corresponding infusions of saline during furosemide inhalations maintained procedural blinding. Average visual analogue scale ratings (%full scale) during the last minute of air hunger or work/effort stimuli were analysed using Linear Mixed Methods. Results. Data from all 16 participants were analysed. Inhaled furosemide relative to inhaled saline significantly improved visual analogues scale ratings of air hunger (Least Squares Mean ± SE − 9.7 ± 2%; p = 0.0015) but not work/effort (+ 1.6 ± 2%; p = 0.903). There were no significant adverse events. Conclusions. Inhaled furosemide was effective at relieving laboratory induced air hunger but not work/effort in healthy adults; this is consistent with the notion that modulation of pulmonary stretch receptor feedback by inhaled furosemide leads to dyspnoea relief that is specific to air hunger, the most unpleasant quality of dyspnoea

Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Opening practice: Supporting Reproducibility and Critical Spatial Data Science

This paper reflects on a number of trends towards a more open and reproducible approach to geographic and spatial data science over recent years. In particular, it considers trends towards Big Data, and the impacts this is having on spatial data analysis and modelling. It identifies a turn in academia towards coding as a core analytic tool, and away from proprietary software tools offering ‘black boxes’ where the internal workings of the analysis are not revealed. It is argued that this closed form software is problematic and considers a number of ways in which issues identified in spatial data analysis (such as the MAUP) could be overlooked when working with closed tools, leading to problems of interpretation and possibly inappropriate actions and policies based on these. In addition, this paper considers the role that reproducible and open spatial science may play in such an approach, taking into account the issues raised. It highlights the dangers of failing to account for the geographical properties of data, now that all data are spatial (they are collected somewhere), the problems of a desire for n = all observations in data science and it identifies the need for a critical approach. This is one in which openness, transparency, sharing and reproducibility provide a mantra for defensible and robust spatial data science