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

Engineering Parallel Symbolic Programs in GPH

We investigate the claim that functional languages offer low-cost parallelism in the context of symbolic programs on modest parallel architectures. In our investigation we present the first comparative study of the construction of large applications in a parallel functional language, in our case in Glasgow Parallel Haskell (GPH). The applications cover a range of application areas, use several parallel programming paradigms, and are measured on two very different parallel architectures.On the applications level the most significant result is that we are able to achieve modest wall-clock speedups (between factors of 2 and 10) over the optimised sequential versions for all but one of the programs. Speedups are obtained even for programs that were not written with the intention of being parallelised, These gains are achieved with a relatively small programmer-effort. One reason for the relative ease of parallelisation is the use of evaluation strategies, a new parallel programming technique that separates the algorithm from the co-ordination of parallel behaviour.On the language level we show that the combination of lazy and parallel evaluation is useful for achieving a high level of abstraction. In particular we can describe top-level parallelism, and also preserve module abstraction by describing parallelism over the data structures provided at the module interface ('data-oriented parallelism'). Furthermore, we find that the determinism of the language is helpful, as is the largely implicit nature of parallelism in GPH. Copyright (C) 1999 John Wiley &amp; Sons, Ltd.</p

Engineering Parallel Symbolic Programs in GPH

We investigate the claim that functional languages offer low-cost parallelism in the context of symbolic programs on modest parallel architectures. In our investigation we present the first comparative study of the construction of large applications in a parallel functional language, in our case in Glasgow Parallel Haskell (GPH). The applications cover a range of application areas, use several parallel programming paradigms, and are measured on two very different parallel architectures.On the applications level the most significant result is that we are able to achieve modest wall-clock speedups (between factors of 2 and 10) over the optimised sequential versions for all but one of the programs. Speedups are obtained even for programs that were not written with the intention of being parallelised, These gains are achieved with a relatively small programmer-effort. One reason for the relative ease of parallelisation is the use of evaluation strategies, a new parallel programming technique that separates the algorithm from the co-ordination of parallel behaviour.On the language level we show that the combination of lazy and parallel evaluation is useful for achieving a high level of abstraction. In particular we can describe top-level parallelism, and also preserve module abstraction by describing parallelism over the data structures provided at the module interface ('data-oriented parallelism'). Furthermore, we find that the determinism of the language is helpful, as is the largely implicit nature of parallelism in GPH. Copyright (C) 1999 John Wiley &amp; Sons, Ltd.</p

The multi-architecture performance of the parallel functional language GPH

In principle, functional languages promise straightforward architecture-independent parallelism, because of their high level description of parallelism, dynamic management of parallelism and deterministic semantics. However, these language features come at the expense of a sophisticated compiler and/or runtime-system. The problem we address is whether such an elaborate system can deliver acceptable performance on a variety of parallel architectures. In particular we report performance measurements for the GUM runtime-system on eight parallel architectures, including massively parallel, distributed-memory, shared-memory and workstation networks.</p

GpH: An Architecture-independent Functional Language

In principle, pure functional languages promise straightforward architecture-independent parallelism. We investigate the validity of this claim in the context of our highly-portable implementation of an implicitly-parallel functional language: the GUM implementation of Glasgow Parallel Haskell (GpH). We discuss architecture independence at two levels: lowlevel (i.e. the implementation) and high-level (i.e. the programmer). Low-level architecture independence is achieved by chosing a message-passing model for GUM, and implementing it using portable C and a widely-supported message-passing library like PVM. In fact GUM is largely independent of the message-passing library, and has been adapted to use MPI and the CM-5 CMMD libraries as well as PVM. As a result, GUM is easily ported, and is currently available on seven platforms including shared-memory machines, distributed-memory machines, and networks of workstations. We provide indicative measurements of how efficient and effective our..

Low level Architecture-independence of Glasgow Parallel Haskell (GpH)

In principle, pure functional languages promise straightforward architecture-independent parallelism. We investigate the validity of this claim in the context of our highly-portable implementation of an implicitly-parallel functional language: the GUM implementation of Glasgow Parallel Haskell (GpH). We focus here on the low-level architecture independence of GUM: the high-level architecture independence of the GpH programming model is discussed elsewhere. Low-level architecture independence is achieved by chosing a message-passing model for GUM, and implementing it using portable C and a widely-supported message-passing library like PVM. In fact GUM is largely independent of the message-passing library, and has been adapted to use MPI and the CM-5 CMMD libraries as well as PVM. As a result, GUM is easily ported, and is currently available on seven platforms including shared-memory machines, distributed-memory machines, and networks of workstations. We provide indicative measurements o..

The Multi-Architecture Performance of the Parallel Functional Language GPH

In principle functional languages promise straightforward architecture-independent parallelism, because of their high level description of parallelism, dynamic management of parallelism and deterministic semantics. However, these language features come at the expense of a sophisticated compiler and/or runtime-system. The problem we address is whether such an elaborate system can deliver acceptable performance on a variety of parallel architectures. In particular we report performance measurements for the GUM runtime-system on eight parallel architectures, including massively parallel, distributed-memory, shared-memory and workstation networks