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

Pan-European δ¹³C values of air and organic matter from forest ecosystems

We present carbon stable isotope, delta C-13, results from air and organic matter samples collected during 98 individual field campaigns across a network of Carboeuroflux forest sites in 2001 (14 sites) and 2002 (16 sites). Using these data, we tested the hypothesis that delta C-13 values derived from large-scale atmospheric measurements and models, which are routinely used to partition carbon fluxes between land and ocean, and potentially between respiration and photosynthesis on land, are consistent with directly measured ecosystem-scale delta C-13 values. In this framework, we also tested the potential of delta C-13 in canopy air and plant organic matter to record regional-scale ecophysiological patterns. Our network estimates for the mean delta C-13 of ecosystem respired CO2 and the related 'discrimination' of ecosystem respiration, delta(er) and Delta(er), respectively, were -25.6 +/- 1.9 parts per thousand and 17.8 +/- 2.0 parts per thousand in 2001 and -26.6 +/- 1.5 parts per thousand and 19.0 +/- 1.6 parts per thousand in 2002. The results were in close agreement with delta C-13 values derived from regional-scale atmospheric measurement programs for 2001, but less so in 2002, which had an unusual precipitation pattern. This suggests that regional-scale atmospheric sampling programs generally capture ecosystem delta C-13 signals over Europe, but may be limited in capturing some of the interannual variations. In 2001, but less so in 2002, there were discernable longitudinal and seasonal trends in delta(er). From west to east, across the network, there was a general enrichment in C-13 (similar to 3 parts per thousand and similar to 1 parts per thousand for the 2 years, respectively) consistent with increasing Gorczynski continentality index for warmer and drier conditions. In 2001 only, seasonal C-13 enrichment between July and September, followed by depletion in November (from about -26.0 parts per thousand to -24.5 parts per thousand to -30.0 parts per thousand), was also observed. In 2001, July and August delta(er) values across the network were significantly related to average daytime vapor pressure deficit (VPD), relative humidity (RH), and, to a lesser degree, air temperature (T-a), but not significantly with monthly average precipitation (P-m). In contrast, in 2002 (a much wetter peak season), delta(er) was significantly related with T-a, but not significantly with VPD and RH. The important role of plant physiological processes on delta(er) in 2001 was emphasized by a relatively rapid turnover (between 1 and 6 days) of assimilated carbon inferred from time-lag analyses of delta(er) vs. meteorological parameters. However, this was not evident in 2002. These analyses also noted corresponding diurnal cycles of delta(er) and meteorological parameters in 2001, indicating a rapid transmission of daytime meteorology, via physiological responses, to the delta(er) signal during this season. Organic matter delta C-13 results showed progressive C-13 enrichment from leaves, through stems and roots to soil organic matter, which may be explained by C-13 fractionation during respiration. This enrichment was species dependent and was prominent in angiosperms but not in gymnosperms. delta C-13 values of organic matter of any of the plant components did not well represent short-term delta(er) values during the seasonal cycle, and could not be used to partition ecosystem respiration into autotrophic and heterotrophic components

Pan-European δ ¹³C values of air and organic matter from forest ecosystems

We present carbon stable isotope, δ13C, results from air and organic matter samples collected during 98 individual field campaigns across a network of Carboeuroflux forest sites in 2001 (14 sites) and 2002 (16 sites). Using these data, we tested the hypothesis that δ13C values derived from large-scale atmospheric measurements and models, which are routinely used to partition carbon fluxes between land and ocean, and potentially between respiration and photosynthesis on land, are consistent with directly measured ecosystem-scale δ13C values. In this framework, we also tested the potential of δ13C in canopy air and plant organic matter to record regional-scale ecophysiological patterns. Our network estimates for the mean δ13C of ecosystem respired CO2 and the related ‘discrimination’ of ecosystem respiration, δer and Δer, respectively, were −25.6±1.9‰ and 17.8 ±2.0‰ in 2001 and −26.6±1.5‰ and 19.0±1.6‰ in 2002. The results were in close agreement with δ13C values derived from regional-scale atmospheric measurement programs for 2001, but less so in 2002, which had an unusual precipitation pattern. This suggests that regional-scale atmospheric sampling programs generally capture ecosystem δ13C signals over Europe, but may be limited in capturing some of the interannual variations. In 2001, but less so in 2002, there were discernable longitudinal and seasonal trends in δer. From west to east, across the network, there was a general enrichment in 13C (∼3‰ and ∼1‰ for the 2 years, respectively) consistent with increasing Gorczynski continentality index for warmer and drier conditions. In 2001 only, seasonal 13C enrichment between July and September, followed by depletion in November (from about −26.0‰ to −24.5‰ to −30.0‰), was also observed. In 2001, July and August δer values across the network were significantly related to average daytime vapor pressure deficit (VPD), relative humidity (RH), and, to a lesser degree, air temperature (Ta), but not significantly with monthly average precipitation (Pm). In contrast, in 2002 (a much wetter peak season), δer was significantly related with Ta, but not significantly with VPD and RH. The important role of plant physiological processes on δer in 2001 was emphasized by a relatively rapid turnover (between 1 and 6 days) of assimilated carbon inferred from time-lag analyses of δer vs. meteorological parameters. However, this was not evident in 2002. These analyses also noted corresponding diurnal cycles of δer and meteorological parameters in 2001, indicating a rapid transmission of daytime meteorology, via physiological responses, to the δer signal during this season. Organic matter δ13C results showed progressive 13C enrichment from leaves, through stems and roots to soil organic matter, which may be explained by 13C fractionation during respiration. This enrichment was species dependent and was prominent in angiosperms but not in gymnosperms. δ13C values of organic matter of any of the plant components did not well represent short-term δer values during the seasonal cycle, and could not be used to partition ecosystem respiration into autotrophic and heterotrophic components

Management effects on European cropland respiration

Increases in respiration rates following management activities in croplands are considered a relevant anthropogenic source of CO₂. In this paper, we quantify the impact of management events on cropland respiration fluxes of CO₂ as they occur under current climate and management conditions. Our findings are based on all available CarboEurope IP eddy covariance flux measurements during a 4-year period (2004–2007). Detailed management information was available for 15 out of the 22 sites that contributed flux data, from which we compiled 30 types of management for European-scale comparison. This allowed us to address the question of how management activities influence ecosystem respiration. This was done by comparing respiration fluxes during 7, 14, and 28 days after the management with those observed during the matching time period before management. Median increases in respiration ranged from +83% (early season tillage) to −50% (rice paddy flooding and burning of rice residues) on the 28 days time scale, when only management types with a minimum of 7 replications are considered. Most management types showed a large variation among events and between sites, indicating that additional factors other than management alone are also important at a given site. Temperature is the climatic factor that showed best correlation with site-specific respiration fluxes. Therefore, the effect of temperature changes between the time periods before and after management were taken into account for a subset of 13 management types with adequate statistical coverage of at least 5 events during the years 2004–2007. In this comparison, late-season moldboard ploughing (30–45 cm) led to highest median increase in respiration on the 7 days timescale (+43%), which was still +15% in the 28 days comparison. On average, however, management-induced increases in respiration losses from croplands were quite moderate (typically <20% increase over 28 days). An assessment of extreme values in daily respiration fluxes using the Gumbel distribution approach revealed that sites with larger average respiration fluxes also experience the larger extremes in respiration fluxes. This suggests that it is very unlikely that sites that generally have low respiration rates will have exceedingly high respiration rates as a result of certain specific management events

The FLUXNET2015 dataset and the ONEFlux processing pipeline for eddy covariance data

Abstract The FLUXNET2015 dataset provides ecosystem-scale data on CO2, water, and energy exchange between the biosphere and the atmosphere, and other meteorological and biological measurements, from 212 sites around the globe (over 1500 site-years, up to and including year 2014). These sites, independently managed and operated, voluntarily contributed their data to create global datasets. Data were quality controlled and processed using uniform methods, to improve consistency and intercomparability across sites. The dataset is already being used in a number of applications, including ecophysiology studies, remote sensing studies, and development of ecosystem and Earth system models. FLUXNET2015 includes derived-data products, such as gap-filled time series, ecosystem respiration and photosynthetic uptake estimates, estimation of uncertainties, and metadata about the measurements, presented for the first time in this paper. In addition, 206 of these sites are for the first time distributed under a Creative Commons (CC-BY 4.0) license. This paper details this enhanced dataset and the processing methods, now made available as open-source codes, making the dataset more accessible, transparent, and reproducible