Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Neutrophil Viability as a Clinical Outcome Marker in Mechanically Ventilated Critically Ill Trauma Patients: A Case Series

Background: Trauma in its early stages leads to an acute inflammatory condition affecting all cellular lines. Neutrophil granulocytes make up the largest population of human white blood cells and are fundamental to the innate immune system. The objective of our pilot study was to evaluate neutrophil death and viability alterations in critically ill trauma patients in correlation with their clinical outcome

Plasma Neutrophil Gelatinase Associated Lipocalin (NGAL) – Early Biomarker for Acute Kidney Injury in Critically Ill Patients

Introduction: NGAL (Neutrophil Gelatinase Associated Lipocalin) is a biomarker recently introduced into clinical practice for the early diagnosis of acute kidney injury (AKI). The aim of this study was to correlate the plasmatic NGAL value determined at admission with clinical progression and severity of AKI in critically ill patients

Factors Favouring the Development of Clostridium Difficile Infection in Critically Ill Patients

Clostridium difficile, an anaerobic, spore-forming, toxin-forming, gram-positive bacillus present in the bacterial flora of the colon is the principal cause of nosocomial diarrhoea in adults

Assessing the suitability of Scarisoara cave ice for glaciochemical research: a coupled chemical and water isotopic approach

Lacustrine sediments are excellent sources of palaeoenvironmental and palaeoclimatic information because they usually provide continuous and high-resolution records. In centraleastern Europe however lacustrine records that extend beyond the Holocene are rather sparse.Palaeomagnetic records from this region are also insufficiently explored, and usually associated with terrestrial deposits such as loess. In this context, the lacustrine record of Lake Sf. Ana, a volcanic crater lake in the East Carpathians, Romania, provides an important archive for reconstructing past paleomagnetic secular variation in the region from early Holocene to late Marine Isotope Stage (MIS) 3.</p

A high-resolution Early Holocene-late MIS 3 environmental rock- and palaeomagnetic record from Lake Sf. Ana, Carpathian Mts, Romania

Lacustrine sediments are excellent sources of palaeoenvironmental and palaeoclimatic information because they usually provide continuous and high-resolution records. In centraleastern Europe however lacustrine records that extend beyond the Holocene are rather sparse.Palaeomagnetic records from this region are also insufficiently explored, and usually associated with terrestrial deposits such as loess. In this context, the lacustrine record of Lake Sf. Ana, a volcanic crater lake in the East Carpathians, Romania, provides an important archive for reconstructing past paleomagnetic secular variation in the region from early Holocene to late Marine Isotope Stage (MIS) 3.</p

Gas Ion Source Performance of the EnvironMICADAS at HEKAL Laboratory, Debrecen, Hungary

A coupled accelerator mass spectrometer–gas interface system has been successfully operating at the Hertelendi Laboratory of Environmental Studies, Debrecen, Hungary, since 2013. Over the last 6 years more than 500 gas targets were measured below 100 µg carbon content for carbon isotopic composition. The system was tested with blanks, OxII, IAEA-C1, IAEA-C2, and IAEA-C7 standards. The performance of our instrumentation shows good agreement with other published gas-interface system data and also shows a quite good agreement with the nominal value of international standard samples. There is a measurable but quite small memory effect after modern samples, but this does not significantly affect the final results. Typical ion currents at the low energy side were between 10–15 µA with a 5% CO2 in He mixing ratio. The relative errors average ±6% for samples greater than or equal to 10 µgC sample with mean count rates of 300 counts per microgram C for OxII. The blank is comparable with other systems, which is 0.0050 ± 0.0018 F14C or 34,000–47,000 yr BP, which allows for the routine measurement of both of small environmental and archeological samples