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

Cartography and Art: A Comparative Study Based on Color

Color occupies a prominent place in the bibliography of cartography, as it is an important element in the formation of cartographic symbolization. Apart from the technical issues of its application to maps, color theory is one of the elements that connect maps with art. In this paper various cartographic trends and their origins are examined and correlated with the artistic periods in which they were developed in order to investigate and document the extent to which maps follow the artistic movements and, particularly in the art of painting, concerning the form and the content of the maps and whether color can be used as an identification element of the art trend and the corresponding period. The research spans from the end of the Middle Ages to the 21st century and is referred spatially in Western Europe, including Italy. The comparison of colors is made in both descriptive and quantitative terms through the commentary of hue, brightness, and saturation, as well as through plotting them in the color wheel, a process that allows an overview of the range and location of color sequences. Concluding, the paintings and maps that were selected and examined in detail support the effect of painting on maps, without implying that it is intentional

Online Map Services: Contemporary Cartography or a New Cartographic Culture?

In this paper, online map services are reviewed from a cartographic point of view. The most popular online map services are selected based on worldwide website traffic data, provided by specialized sites, such as Similarweb, in terms of global coverage and popularity among users. Online map services are commented based on cartographic principles, conventions and traditional practices addressing topics, such as: Cartographic projection, orientation, scale, marginalia, content (thematic layers), symbology, generalization, annotation, color use and overall map design. Color schemes utilized in web maps are discussed in more detail, since based on studies concerning the selection of the preferable map by experts and laymen, color is undisputedly the most frequently mentioned factor. It can be stated that online map services generally adopt well-known cartographic practices, which are not always applied as expected. Moreover, suggestions for the improvement of online map services are made regarding cartographic projection, legend, content, symbolization, color, etc

Map and art: color as a critical parameter

This doctoral dissertation entitled "Map and Art. Color as a Critical Parameter" aims to bring to light the strong relationship between Cartography and Art. Throughout this study, it is attempted to identify the role of color - which is an inherent and significant element in shaping both cartographic products and painting products - as a critical factor and link between them. For this reason, the elements related to the knowledge of color through different approaches, as well as the elements related to its use, will be listed and analyzed as well. It is cited how color is approached in cartographic literature and to what extent its utilization by the cartographers takes into account its artistic and aesthetic approach. Τhe time frame of this process spans from the end of the Middle Ages and the Gothic style (13th century) to the beginning of the 21st century and is spatially referred mainly to western Europe. For each artistic period under consideration, representative paintings are cited, and for each one of them, the color sequence used to form it is identified and recorded in the color wheel. For the same period, maps of the same era are searched for, and in the same way for each of them, the color sequence on which they are based is identified and recorded in the color wheel. Colors are compared both in descriptive terms, luminance and saturation, and quantitatively, by recording in the color circle, a process that allows an overview of the range and position of color sequences. Paintings are the application field of color characteristics, the field of bringing out the relationships of colors, as well as the simultaneous contrast, and It can become the source of inspiration for creative cartographic composition. The visual differentiation of colors in paintings as well as on maps over time over time is also noted. The study of paintings and the ability to identify the respective period or artistic movement based on how the color was used is an important tool that can be used in depth both in the composition of the map and in the judgment of the cartographic result. This dissertation presents the elements that substantiate the possibility of comparing color standardization in Painting and Cartography, the function of color as a link between paintings and maps in various time and artistic periods, the extraction of knowledge from the temporal differentiation of the visual characteristics of colors, and finally the diachronic dialogue between Cartography and Art over time.Στη διδακτορική διατριβή με τίτλο "Χάρτης και Τέχνη. Tο χρώμα ως κρίσιμη παράμετρος", επιχειρείται να αναδειχθεί η άρρηκτη σχέση της Χαρτογραφίας με την Τέχνη, μέσω της μελέτης του ρόλου του χρώματος που αποτελεί σημαντικό στοιχείο μορφοποίησης τόσο στα χαρτογραφικά προϊόντα όσο και στα ζωγραφικά έργα. Γίνεται αναφορά στη θεωρία του χρώματος μέσω της επιστημονικής, της ψυχολογικής και της φιλοσοφικής προσέγγισης και εξετάζεται το πώς αναλύεται, περιγράφεται και χρησιμοποιείται το χρώμα τόσο από τους ζωγράφους όσο και από τους χαρτογράφους. Η χρονική τοποθέτηση του θέματος ξεκινά από το τέλος του Μεσαίωνα κατά τον 13ο αιώνα και καταλήγει στις αρχές του 21ου, ενώ η τοποθέτηση στον χώρο γίνεται στη Δυτική Ευρώπη, αφορά δηλαδή κατά κύριο λόγο στον δυτικοευρωπαϊκό πολιτισμό. Σε αυτό το πλαίσιο, διερευνάται η ιστορία του χρώματος στη ζωγραφική, συσχετίζονται οι χαρτογραφικές σχολές με τις καλλιτεχνικές περιόδους, προκειμένου να απαντηθεί το ερώτημα εάν και σε ποιο βαθμό οι χάρτες ακολουθούν τα καλλιτεχνικά ρεύματα και εάν μπορεί να χρησιμοποιηθεί το χρώμα ως στοιχείο αναγνώρισης της σχολής και της αντίστοιχης περιόδου. Για κάθε καλλιτεχνική περίοδο που εξετάζεται, παρατίθενται αντιπροσωπευτικά ζωγραφικά έργα και για κάθε ένα από αυτά, προσδιορίζεται η χρωματική ακολουθία που έχει χρησιμοποιηθεί για τη μορφοποίησή του και καταγράφεται στον χρωματικό κύκλο. Για την ίδια περίοδο, αναζητούνται χάρτες της ίδιας εποχής και με τον ίδιο τρόπο για κάθε έναν από αυτούς προσδιορίζεται και καταγράφεται στον χρωματικό κύκλο η χρωματική ακολουθία στην οποία στηρίζεται. Η σύγκριση των χρωμάτων γίνεται τόσο με περιγραφικούς όρους μέσω του σχολιασμού της απόχρωσης, της φωτεινότητας και του κορεσμού όσο και με ποσοτικούς, μέσω της καταγραφής στον χρωματικό κύκλο, διαδικασία που επιτρέπει την επισκόπηση του εύρους και της θέσης των χρωματικών ακολουθιών. Τα ζωγραφικά έργα αποτελούν πεδίο υλοποίησης των χαρακτηριστικών του χρώματος, πεδίο ανάδειξης των σχέσεων των χρωμάτων και της ταυτόχρονης αντίθεσης και μπορούν να αποτελέσουν πηγή έμπνευσης για τη δημιουργική χαρτογραφική σύνθεση. Σημειώνεται επίσης, η διαχρονική διαφοροποίηση του χρωματικού χαρακτήρα των χρωμάτων τόσο στο ταξίδι του χρώματος στα ζωγραφικά έργα όσο και στους χάρτες. Η μελέτη των ζωγραφικών έργων και η δυνατότητα αναγνώρισης της αντίστοιχης περιόδου ή του αντίστοιχου καλλιτεχνικού ρεύματος με βάση το πώς χρησιμοποιήθηκε το χρώμα, αποτελεί σημαντικό εφόδιο που μπορεί να αξιοποιηθεί σε βάθος τόσο στη σύνθεση του χάρτη όσο και στην κρίση του χαρτογραφικού αποτελέσματος. Στη διατριβή αυτή παρουσιάζονται ενδελεχώς τα στοιχεία που τεκμηριώνουν τη δυνατότητα σύγκρισης της τυποποίησης του χρώματος στη Ζωγραφική και τη Χαρτογραφία, τη λειτουργία του χρώματος ως συνδετικού κρίκου ανάμεσα στα ζωγραφικά έργα και τους χάρτες σε διάφορες χρονικές και καλλιτεχνικές περιόδους, την άντληση γνώσης από τη διαχρονική διαφοροποίηση των οπτικών χαρακτηριστικών των χρωμάτων και εν τέλει τον διαχρονικό διάλογο Χαρτογραφίας και Τέχνης

Generalization of Soundings across Scales: From DTM to Harbour and Approach Nautical Charts

This paper presents an integrated digital methodology for the generalization of soundings. The input for the sounding generalization procedure is a high resolution Digital Terrain Model (DTM) and the output is a sounding data set appropriate for portrayal on harbour and approach Electronic Navigational Charts (ENCs). The sounding generalization procedure follows the &ldquo;ladder approach&rdquo; that is a requisite for the portrayal of soundings on nautical charts, i.e., any sounding portrayed on a smaller scale chart should also be depicted on larger scale charts. A rhomboidal fishnet is used as a supportive reference structure based on the cartographic guidance for soundings to display a rhombus pattern on nautical charts. The rhomboidal fishnet cell size is defined by the depth range and the compilation scale of the charted area. Generalization is based on a number of rules and constraints extracted from International Hydrographic Organization (IHO) standards, hydrographic offices&rsquo; best practices and the cartographic literature. The sounding generalization procedure can be implemented using basic geoprocessing functions available in the most commonly used Geographic Information System (GIS) environments. A case study was performed in the New York Lower Bay area based on a high resolution National Oceanic and Atmospheric Administration (NOAA) DTM. The method successfully produced generalized soundings for a number of Harbour and Approach nautical charts at 10 K, 20 K, 40 K and 80 K scales

Immunocompromised patients with acute respiratory distress syndrome : Secondary analysis of the LUNG SAFE database

The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the LUNG SAFE database

Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p &lt; 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p &lt; 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Mechanical ventilation in patients with cardiogenic pulmonary edema : a sub-analysis of the LUNG SAFE study

Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/hospital mortality) were assessed using latent mixture analysis and a marginal structural model. From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59-78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57-77] vs 74 [64-80] years, p < 0.001) and had lower driving (12 [8-16] vs 15 [11-17] cmHO, p < 0.001), plateau (20 [15-23] vs 22 [19-26] cmHO, p < 0.001) and peak (21 [17-27] vs 26 [20-32] cmHO, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60-1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16-2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06-1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52-0.93], p = 0.015) were related to survival. Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury. Trial registration Clinicaltrials.gov NCT02010073

Mechanical ventilation in patients with cardiogenic pulmonary edema: a sub-analysis of the LUNG SAFE study

International audienceBackground: Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Methods: Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/ hospital mortality) were assessed using latent mixture analysis and a marginal structural model. Results: From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59-78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57-77] vs 74 [64-80] years, p < 0.001) and had lower driving (12 [8-16] vs 15 [11-17] cmH 2 O, p < 0.001), plateau (20 [15-23] vs 22 [19-26] cmH 2 O, p < 0.001) and peak (21 [17-27] vs 26 [20-32] cmH 2 O, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60-1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16-2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06-1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52-0.93], p = 0.015) were related to survival. Conclusions: Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury