Early versus Late Tracheostomy Promotes Weaning in Intensive Care Unit Patients

Background and aim of the study: The time interval between the patients’ intubation and the performance of a tracheostomy has been considered as critical for the disease prognosis and outcome. The aim of the present study was to compare and contrast the outcomes of early vs late tracheostomy with regard to intensive care unit (ICU) patients’ weaning from respiratory support. Methods: This retrospective observational study, involved patients who were hospitalized in two general and one Covid-19 ICUs of two tertiary hospitals in Athens and were subjected to tracheostomy. Data were collected from the patients’ medical records in order to estimate the duration of patient weaning and the number of days from the patients’ intubation until the time of tracheostomy. In the present study the term early tracheostomy denotes tracheostomy performed within 14 days from patient intubation and late tracheostomy defines the tracheostomy carried out after 14 days. For Covid-19 patients, guidelines suggested that tracheostomies should be performed 21 days following intubation, due to the high risk of virus transmission. Results: One hundred and thirty-one patients who underwent tracheostomy participated in the study. Most tracheostomies were performed using the percutaneous technique. The group of patients tracheostomized within 14 days after their admission in ICU weaned faster from respiratory support compared to ones who were tracheostomized after 14 days. Conclusions: The most common distinction between early and late tracheostomy is 14 days, with early tracheostomy being more beneficial in terms of patients’ outcomes, and specifically ICU patients’ weaning. (www.actabiomedica.it)

Cumulative Prognostic Score Predicting Mortality in Patients Older Than 80 Years Admitted to the ICU.

OBJECTIVES: To develop a scoring system model that predicts mortality within 30 days of admission of patients older than 80 years admitted to intensive care units (ICUs). DESIGN: Prospective cohort study. SETTING: A total of 306 ICUs from 24 European countries. PARTICIPANTS: Older adults admitted to European ICUs (N = 3730; median age = 84 years [interquartile range = 81-87 y]; 51.8% male). MEASUREMENTS: Overall, 24 variables available during ICU admission were included as potential predictive variables. Multivariable logistic regression was used to identify independent predictors of 30-day mortality. Model sensitivity, specificity, and accuracy were evaluated with receiver operating characteristic curves. RESULTS: The 30-day-mortality was 1562 (41.9%). In multivariable analysis, these variables were selected as independent predictors of mortality: age, sex, ICU admission diagnosis, Clinical Frailty Scale, Sequential Organ Failure Score, invasive mechanical ventilation, and renal replacement therapy. The discrimination, accuracy, and calibration of the model were good: the area under the curve for a score of 10 or higher was .80, and the Brier score was .18. At a cut point of 10 or higher (75% of all patients), the model predicts 30-day mortality in 91.1% of all patients who die. CONCLUSION: A predictive model of cumulative events predicts 30-day mortality in patients older than 80 years admitted to ICUs. Future studies should include other potential predictor variables including functional status, presence of advance care plans, and assessment of each patient's decision-making capacity

Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study.

BACKGROUND: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. RESULTS: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85]. CONCLUSIONS: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study.

BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

Measurements and modelling of tracer gas distribution in a naturally ventilated greenhouse for pesticide dispersion determination

In this study numerical and experimental results concerning the dispersion of a tracer gas (N2O) inside an experimental greenhouse with a tomato crop were presented and analyzed. The proposed simulation concerns a greenhouse block located in the University of Thessaly near Volos, the continental area of eastern Greece. The tracer gas was injected into the greenhouse, and after its homogenization, vents were opened and simultaneously wind velocity, wind direction and gas concentration were recorded. Air samples were continuously taken at six points in the greenhouse and in two positions outside the greenhouse using a multiple inlet infrared gas analyser. In the numerical model, calculations were made for several combinations of wind speed and direction. In first set, used to validate the numerical model, experimental values were used for the boundary conditions. The final solution for every case was obtained, firstly by a convergent solution under steady - state conditions and secondly by an unsteady one, where at time zero the volume of the experimental greenhouse was considered to contain a new mixture of 'air' and 'N2O'. Good overall agreement was found between the experimental and simulated data. The simulation results provided useful information about the emission of N 2O around the experimental greenhouse and are a first step towards the determination of the behaviour of pesticides around greenhouses

Effect of two new cover materials on greenhouse energy consumption and cooling load

The aim of this work was to study the effects of a new polyethylene (PE) film with high reflectance and absorption in near infrared radiation (NIR-PE film) and of a PE film with low transmittance in infrared radiation IR (IR-PE film), on the greenhouse microclimate, energy consumption and on growth and yield of a hydroponic tomato crop. Compared to a common PE film (C-PE), the IR-PE film, had 75% lower transmittance in IR, while the NIR-PE had 78% lower transmittance in IR and 42% higher reflectance in NIR. Films were evaluated experimentally in three similar arched roof greenhouses, two covered with the new covering materials and the third one by a C-PE film. The greenhouse and outside microclimate parameters along with crop growth and production were recorded. During the winter period, no significant differences of air temperature and relative air humidity between the tested greenhouses were found. The air vapour pressure deficit (VPD) values observed were relatively low (i.e below 0.5 kPa) during the night period, leading to condensation over the cover. The total energy consumption was 10% lower in the IR-PE covered greenhouse than in the C-PE covered greenhouse. During the summer period, the air temperature in the greenhouse covered by the NIR-PE was 2°C lower than the air temperature of the C-PE covered greenhouse

Internet of Things in agriculture, recent advances and future challenges

The increasing demand for food, both in terms of quantity and quality, has raised the need for intensification and industrialisation of the agricultural sector. The “Internet of Things” (IoT) is a highly promising family of technologies which is capable of offering many solutions towards the modernisation of agriculture. Scientific groups and research institutions, as well as the industry, are in a race trying to deliver more and more IoT products to the agricultural business stakeholders, and, eventually, lay the foundations to have a clear role when IoT becomes a mainstream technology. At the same time Cloud Computing, which is already very popular, and Fog Computing provide sufficient resources and solutions to sustain, store and analyse the huge amounts of data generated by IoT devices. The management and analysis of IoT data (“Big Data”) can be used to automate processes, predict situations and improve many activities, even in real-time. Moreover, the concept of interoperability among heterogeneous devices inspired the creation of the appropriate tools, with which new applications and services can be created and give an added value to the data flows produced at the edge of the network. The agricultural sector was highly affected by Wireless Sensor Network (WSN) technologies and is expected to be equally benefited by the IoT. In this article, a survey of recent IoT technologies, their current penetration in the agricultural sector, their potential value for future farmers and the challenges that IoT faces towards its propagation is presented. © 2017 IAgr

Dispersion of pesticides from a naturally ventilated greenhouse: A CFD approach

A methodology of application of a numerical technique in order to simulate the dispersion of pesticides from greenhouses is presented. The proposed simulation approach is based on preliminary calculations that concern the greenhouse-block located in the University of Thessaly near Volos, on the coastal area of Eastern Greece. A 3D simulation model was developed using the commercial CFD code Fluent with the realizable k-ε turbulence model in order to simulate the air flow inside and around the experimental greenhouse. The ventilation process, through which the pesticide pollutants are emitted from the experimental greenhouse's side openings, was analyzed by simulating the dispersion of a tracer gas (Nitrous Oxide, N2O) which was used for the first sequence of experiments. The simulation results provided useful information about the dispersion of N2O around the experimental greenhouse, showing that wind characteristics dominate both the ventilation rate and dispersion of the tracer gas. Through this approach the determination of the critical points, where the measurement instruments have to be located during the experimental process are identified according to wind velocity and direction. In addition, useful conclusions were obtained concerning the set up of simulation model, showing how to improve the accuracy of computational predictions

Characteristics and Survival Rates in Ward Patients Requiring Evaluation by Intensivist in Greece

Introduction: Patients at risk should be admitted to the ICU if there is room for improvement. Patients who have no room for improvement or the risk of death is either too high or too low should not be admitted to the ICU. Aim: To investigate ward patient characteristics, outcomes, and survival rates after an emergency call for evaluation by an intensivist. Material and Method: This is a prospective observational study of patients hospitalized at a general hospital in Greece. A data recording form was completed by the investigators in order to collect the required data. Results: 115 patients (58.3%, n = 67 men and 41.7%, n = 48 women) of mean age 67.1 ± 13.8 years (range 27–92 years) were evaluated by an intensivist and were recorded. 28.7% (n = 33) were hospitalized in a surgical clinic, 67% (n = 77) were hospitalized in internal medicine clinics (oncology), and 4.3% (n = 5) of the patients were treated in the emergency department, the radiotherapy department, or the radiology department. 73% (n = 84/115) of the patients were hospitalized in the ICU. Total survival rate was 49.6% (57/115). Of the 31 patients who did not enter the ICU (out of 115 patients), 15 survived (13% of the 115 patients or 48.4% of the 31 patients not admitted to the ICU). Five (5) of them had a cardiac arrest and either died without entering the ICU or continued their hospitalization in the ward. The survival rates of the patients not admitted to the ICU who continued hospitalization at the ward was 57.7% (15/26). Of the 84 patients admitted to the ICU, 42 survived (36.5% of the 115 patients or 50% of the 84 patients admitted to the ICU). Conclusions: The survival rates of these patients are quite low and possibly multifactorial due to the severity of the disease, the unnecessary call for an intensivist due to an irreversible condition, or the delayed call of an intensivist. © Springer Nature Switzerland AG 2020

A climate control methodology based on wireless sensor networks in greenhouses

This work proposes the design and operation methodologies of a wireless sensor network (WSN) in the greenhouse environment that can lead to the development of an advanced, distributed monitoring and control system. The combined use of conventional sensors with remote sensing technology embedded in a WSN, together with processing algorithms that provide the synthesized information (e.g., performance indicators) required for optimal greenhouse control and decision making, lead to the development of an integrated climate monitoring and control system, towards the realization of precision greenhouse horticulture. Several specific problems related to greenhouse environments are addressed in this work, towards the feasibility of WSNs usage inside the greenhouse, like wireless nodes packaging, standardization of WSN components, electromagnetic fields interference, effects of greenhouse cover materials, etc. The performance of the fine-tuned WSN is evaluated, based on real-time measurements and communication and energy consumption metrics