Temporal changes in the epidemiology, management, and outcome from acute respiratory distress syndrome in European intensive care units: a comparison of two large cohorts

Background: Mortality rates for patients with ARDS remain high. We assessed temporal changes in the epidemiology and management of ARDS patients requiring invasive mechanical ventilation in European ICUs. We also investigated the association between ventilatory settings and outcome in these patients. Methods: This was a post hoc analysis of two cohorts of adult ICU patients admitted between May 1–15, 2002 (SOAP study, n = 3147), and May 8–18, 2012 (ICON audit, n = 4601 admitted to ICUs in the same 24 countries as the SOAP study). ARDS was defined retrospectively using the Berlin definitions. Values of tidal volume, PEEP, plateau pressure, and FiO2 corresponding to the most abnormal value of arterial PO2 were recorded prospectively every 24 h. In both studies, patients were followed for outcome until death, hospital discharge or for 60 days. Results: The frequency of ARDS requiring mechanical ventilation during the ICU stay was similar in SOAP and ICON (327[10.4%] vs. 494[10.7%], p = 0.793). The diagnosis of ARDS was established at a median of 3 (IQ: 1–7) days after admission in SOAP and 2 (1–6) days in ICON. Within 24 h of diagnosis, ARDS was mild in 244 (29.7%), moderate in 388 (47.3%), and severe in 189 (23.0%) patients. In patients with ARDS, tidal volumes were lower in the later (ICON) than in the earlier (SOAP) cohort. Plateau and driving pressures were also lower in ICON than in SOAP. ICU (134[41.1%] vs 179[36.9%]) and hospital (151[46.2%] vs 212[44.4%]) mortality rates in patients with ARDS were similar in SOAP and ICON. High plateau pressure (> 29 cmH2O) and driving pressure (> 14 cmH2O) on the first day of mechanical ventilation but not tidal volume (> 8 ml/kg predicted body weight [PBW]) were independently associated with a higher risk of in-hospital death. Conclusion: The frequency of and outcome from ARDS remained relatively stable between 2002 and 2012. Plateau pressure > 29 cmH2O and driving pressure > 14 cmH2O on the first day of mechanical ventilation but not tidal volume > 8 ml/kg PBW were independently associated with a higher risk of death. These data highlight the continued burden of ARDS and provide hypothesis-generating data for the design of future studies

The clinical relevance of oliguria in the critically ill patient : Analysis of a large observational database

Funding Information: Marc Leone reports receiving consulting fees from Amomed and Aguettant; lecture fees from MSD, Pfizer, Octapharma, 3 M, Aspen, Orion; travel support from LFB; and grant support from PHRC IR and his institution. JLV is the Editor-in-Chief of Critical Care. The other authors declare that they have no relevant financial interests. Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.publishersversionPeer reviewe

Effect of algae Chlorella vulgaris on survival of bacteria Lactobacillus brevis at high concentrations of sodium chloride

Połączenie alg z produktami fermentowanymi bogatymi w bakterie fermentacji mlekowej przynosi wiele korzyści zdrowotnych oraz pozwala na utworzenie nowego segmentu żywności fermentowanej. Jedną z efektywnych metod utrwalania żywności jest stosowanie procesu odwodnienia osmotycznego polegającego na dodaniu substancji (np. chlorku sodu) obniżającej aktywność wody w produkcie. Celem pracy było określenie wpływu Chlorella vulgaris na przeżywalność bakterii Lactobacillus brevis w niekorzystnych warunkach środowiskowych (duże stężenia chlorku sodu) metodą płytkową oraz turbidymetryczną. Zawartość 5 i 10 % chlorku sodu w środowisku wzrostowym bakterii obniżyła staty- stycznie istotnie liczbę badanych bakterii fermentacji mlekowej. Jednakże dodatek alg Chlorella vulgaris zabezpieczył badane szczepy Lactobacillus brevis przed obumieraniem. Ponadto w przypadku szczepów Lactobacillus brevis ŁOCK 0944 oraz ŁOCK 0992 nie zaobserwowano różnic statystycznie istotnych pomiędzy próbą kontrolną z bakteriami i Chlorella vulgaris a próbą badaną z bakteriami, algami oraz dodatkiem 10 % chlorku sodu w 48 godzinie inkubacji. Zatem wprowadzenie alg do środowiska wzrosto- wego bakterii fermentacji mlekowej zredukowało niekorzystne działanie chlorku sodu o stężeniu 10 %. Stwierdzono, że przeżywalność wszystkich badanych szczepów Lactobacillus brevis hodowanych w obecności Chlorella vulgaris po 48-godzinnej inkubacji była wyższa w środowisku o stężeniu 10 % chlorku sodu niż w obecności 5 %. Za pomocą skaningowej mikroskopii elektronowej (SEM) stwierdzo- no, że prawdopodobnie spowodowane to było uwolnieniem dodatkowej treści komórek alg

Quick Determination of Electroactive Surface Area of Some Oxide Electrocatalysts

International audienceMetal oxides are important functional materials with a wide range of applications, especially in the field of electrocatalysis. However, quick and accurate assessment of their real electroactive surface area (ECSA), which is of paramount importance for the evaluation of their performance, remains a challenging task. In the presentation, I will present a relatively simple strategy for an accurate in situdetermination of the ECSA of commonly used metal oxide catalysts, namely: Ni-, Co-, Fe-, Pt-and Ir-based oxides. Similar to the well-established practice in electrocatalysis, the method is based on the phenomenon of specific adsorption. It uses the fact that,at the electrode potentials close to the onset of the oxygen evolution reaction (OER), specifically adsorbed reaction intermediates manifest themselves through so-called adsorption capacitance, which is unambiguously detectable using electrochemical impedance spectroscopy.[1,2] With simple impedance measurements, experimentalists can acquire the adsorption capacitance values and accurately estimate the real electroactive surface area of the above-mentioned oxide materials, including nanostructured electrocatalysts. Additionally, as illustrative examples, I will demonstrate an application of the method for the determination of the ECSA of oxide catalyst nanoparticles