16 research outputs found

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

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    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

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    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

    Optimization of Technology of Canned Meat Products

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    It was determined the parameters of quality of functional canned mince meat productsoptimized by adding of preparations of proteins of blood plasma (2%) and cellular tissues (2.5%), and developed the optimized technology of their production

    Nonlinear Ferromagnetic Resonance in Nanostructures Having Discrete Spectrum of Spin-Wave Modes

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    International audienceNonlinear ferromagnetic resonance (NFMR) at the nanoscale differs from the same phenomenon in bulk magneticsamples due to the nanosize-related discreteness of the spin wave spectrum. Because of the spectrum discreteness,the conservation laws for multiwave parametric interaction processes cannot be fulfilled exactly and become nonresonant.The presence of the nonresonant parametric processes in a strongly driven magnetic nanosystem can be detectedexperimentally as distortions on the NFMR curve caused by the nonresonant excitation of spin wave modes

    Simultaneous multitone microwave emission by DC-driven spintronic nano-element

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    Current-induced self-sustained magnetization oscillations in spin-torque nano-oscillators (STNOs) are promising candidates for ultra-agile microwave sources or detectors. While usually STNOs behave as a monochrome source, we report here clear bimodal simultaneous emission of incommensurate microwave oscillations, where the two tones correspond to two parametrically coupled eigenmodes with tunable splitting. The emission range is crucially sensitive to the change in hybridization of the eigenmodes of free and fixed layers, for instance, through a slight tilt of the applied magnetic field from the normal of the nano-pillar. Our experimental findings are supported both analytically and by micromagnetic simulations, which ascribe the process to four-magnon scattering between a pair of radially symmetric magnon modes and a pair of magnon modes with opposite azimuthal index. Our findings open up new possibilities for cognitive telecommunications and neuromorphic systems that use frequency multiplexing to improve communication performance

    Simultaneous multitone microwave emission by DC-driven spintronic nano-element

    No full text
    Current-induced self-sustained magnetization oscillations in spin-torque nano-oscillators (STNOs) are promising candidates for ultra-agile microwave sources or detectors. While usually STNOs behave as a monochrome source, we report here clear bimodal simultaneous emission of incommensurate microwave oscillations, where the two tones correspond to two parametrically coupled eigenmodes with tunable splitting. The emission range is crucially sensitive to the change in hybridization of the eigenmodes of free and fixed layers, for instance, through a slight tilt of the applied magnetic field from the normal of the nano-pillar. Our experimental findings are supported both analytically and by micromagnetic simulations, which ascribe the process to four-magnon scattering between a pair of radially symmetric magnon modes and a pair of magnon modes with opposite azimuthal index. Our findings open up new possibilities for cognitive telecommunications and neuromorphic systems that use frequency multiplexing to improve communication performance

    A worldwide perspective of sepsis epidemiology and survival according to age: Observational data from the ICON audit

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    Purpose: To investigate age-related differences in outcomes of critically ill patients with sepsis around the world. Methods: We performed a secondary analysis of data from the prospective ICON audit, in which all adult ( >16 years ) patients admitted to participating ICUs between May 8 and 18, 2012, were included, except admissions for routine postoperative observation. For this sub-analysis, the 10,012 patients with completed age data were included. They were divided into five age groups - <= 50, 51-60, 61-70, 71-80, >80 years. Sepsis was defined as infection plus at least one organ failure. Results: A total of 2963 patients had sepsis, with similar proportions across the age groups (<= 50 = 25.2%: 51-60 = 30.3%; 61-70 = 32.8%; 71-80 = 30.7%; >80 = 30.9%). Hospital mortality increased with age and in patients >80 years was almost twice that of patients <= 50 years (493% vs 25.2%, p < .05). The maximum rate of increase in mortality was about 0.75% per year, occurring between the ages of 71 and 77 years. In multilevel analysis, age > 70 years was independently associated with increased risk of dying. Conclusions: The odds for death in ICU patients with sepsis increased with age with the maximal rate of increase occurring between the ages of 71 and 77 years. (C) 2019 Elsevier Inc. All rights reserved

    Comparison of European ICU patients in 2012 (ICON) versus 2002 (SOAP)

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    Purpose: To evaluate differences in the characteristics and outcomes of intensive care unit (ICU) patients over time. Methods: We reviewed all epidemiological data, including comorbidities, types and severity of organ failure, interventions, lengths of stay and outcome, for patients from the Sepsis Occurrence in Acutely ill Patients (SOAP) study, an observational study conducted in European intensive care units in 2002, and the Intensive Care Over Nations (ICON) audit, a survey of intensive care unit patients conducted in 2012. Results: We compared the 3147 patients from the SOAP study with the 4852 patients from the ICON audit admitted to intensive care units in the same countries as those in the SOAP study. The ICON patients were older (62.5 ± 17.0 vs. 60.6 ± 17.4 years) and had higher severity scores than the SOAP patients. The proportion of patients with sepsis at any time during the intensive care unit stay was slightly higher in the ICON study (31.9 vs. 29.6%, p = 0.03). In multilevel analysis, the adjusted odds of ICU mortality were significantly lower for ICON patients than for SOAP patients, particularly in patients with sepsis [OR 0.45 (0.35–0.59), p < 0.001]. Conclusions: Over the 10-year period between 2002 and 2012, the proportion of patients with sepsis admitted to European ICUs remained relatively stable, but the severity of disease increased. In multilevel analysis, the odds of ICU mortality were lower in our 2012 cohort compared to our 2002 cohort, particularly in patients with sepsis. © 2018, The Author(s)
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