Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Sinopse das espécies nativas e subespontâneas de Andropogoneae Dumort. (Poaceae) na Ilha de Santa Catarina, Brasil A synopsis of the Andropogoneae Dumort. (Poaceae) native and subspontaneous to the Island of Santa Catarina, Florianópolis, SC, Brazil

O presente trabalho consiste no levantamento dos táxons da tribo Andropogoneae (Panicoideae - Poaceae) ocorrentes na Ilha de Santa Catarina, Florianópolis, Brasil. A partir da revisão de materiais de herbários e coletas a campo foi confirmada a ocorrência de 10 gêneros e 20 espécies, 17 nativas e duas subespontâneas: Andropogon L. (7 spp.), Bothriochloa Kuntze (2), Eriochrysis P. Beauv. (1), Hyparrhenia Andersson ex E. Fourn. (1), Imperata Cirillo (1), Ischaemum L. (1), Rhytachne Desv. (1), Saccharum L. (3), Schizachyrium Nees (2) e Sorghum Moench (1). Os gêneros Bothriochloa e Rhytachne são registrados pela primeira vez para a Ilha de Santa Catarina. São apresentadas chaves de identificação para gêneros e espécies, ilustrações, informações sobre distribuição geográfica, habitat, período de floração e comentários para cada táxon.<br>The present work is a survey of the taxa in the tribe Andropogoneae (Panicoideae - Poaceae) that occur on the Island of Santa Catarina, Florianópolis, Brazil. Based on a review of herbarium specimens and fieldwork, 20 species were recorded in the following 10 genera: Andropogon L. (7 spp.), Bothriochloa Kuntze (2), Eriochrysis P. Beauv. (1), Hyparrhenia Andersson ex E. Fourn. (1), Imperata Cirillo (1), Ischaemum L. (1), Rhytachne Desv. (1), Saccharum L. (3), Schizachyrium Nees (2) and Sorghum Moench (1). Seventeen of the species are native, and two species are subspontaneous. Bothriochloa and Rhytachne are recorded here, for the first time, for the Island of Santa Catarina. This work provides key to the genera and species, as well as illustrations, information about geographic distribution, habitat, phenology, and comments about each taxon presented in the study

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