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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Volcanoes in motion: El Hierro and La Palma (Canary Islands)

Ten informative panels were designed to organize an exhibition of the LAJIAL project results about the recent volcanism of El Hierro Island and the 2021 eruption in La Palma Island. The format was self-rolling panels (roll-ups) 1 m wide by 2 m high, easily transportable, and highly protective. This exhibition was entitled 'Volcanoes in motion: El Hierro and La Palma' and allows us to understand that the volcanic phenomenon is very dynamic and capable of quickly changing the forms of relief, the water network, or the land use. The presentation in all these panels always keeps the same content: an upper strip including the titles of the exhibition, the thematic block, and the panel, as well as its numbering and logos of the promoting entities; a central part with much visual information in the form of maps, figures and photos accompanied by concise and easy-to-read texts; and a lower strip with the credits of the authors and logos of their institutions. The first block of panels, 'A sea of volcanoes', deals with the generation of intraplate volcanic islands, with the example of the Canary Islands (Panel 1: The Canary Islands, that is how it all began) and the geological evolution of the island of El Hierro (Panel 2: And El Hierro was born). The second block, 'Volcanic landscapes of El Hierro', focuses on geological structures on a large scale (Panel 3: Megastructures) and a small scale (Panel 4: Structures on the ground). The third block, 'Explore your volcanic paradise', pays homage to the geological maps and the last eruption on El Hierro island. Panel 5: Walking among volcanoes shows the Gorona del Lajial eruption, a true paradise of volcanic structures but a geological puzzle solved within the framework of the LAJIAL project. Panel 6: 'The last volcano' is dedicated to the eruption of the Tagoro submarine volcano. The fourth block, 'Living among volcanoes', focuses on the islander's adaptation to the volcanic territory through the rational exploitation of groundwater (Panel 7: Water on El Hierro), volcanic materials as construction elements, or the figure of the UNESCO Geopark of El Hierro (Panel 8: What the land tells us), which brings together the geology of the island with its inhabitants, promoting the sustainable development, its agricultural techniques or knowledge of its archaeological remains. The last block of two panels, 'La Palma: the pretty island' is devoted to the geological evolution of La Palma island (Panel 9: And La Palma was born) and the 2021 eruption of Tajogaite volcano (Panel 10: The eruption of 2021) that represent the last volcanic activity in the archipelago.Project LAJIAL, Grant PGC2018-101027-B-I00 funded by MCIN/AEI/10.13039/ 501100011033 and by "ERDF A way of making Europe", by the "European Union"PhD Grant 2021 FISDU 00347, Departament de Recerca i Universitats, Generalitat de CatalunyaResearch Consolidated Group GEOVOL (Universidad de Las Palmas de Gran Canaria)Research Consolidated Group GEOPAM (Generalitat de Catalunya, 2017 SGR 1494)Peer reviewe

Volcanes en movimiento: El Hierro y La Palma

Paneles expositivos para la divulgación del volcanismo en las islas de El Hiero y La Palma en colaboración con la Asociación Española para la Enseñanza de las Ciencias de la Tierra (AEPECT)[EN] We explain the geological history of the island of El Hierro and the 2021 eruption in the island of La Palma through a collection of ten panels. How the Canary Islands were formed and evolved is contextualized, and we introduce the birth of El Hierro. Next, we observe the landscapes of El Hierro as a response to macro-scale, such as giant landslides and rifts, and micro-scale phenomena (cones, lavas, and shore platforms). The last eruption of the island that gave rise to the Tagoro submarine volcano is also exposed. In addition, we present how the Herreños have adapted to the territory, knowing how to take advantage of its scarce water resources and adapt their way of life to the volcanic landscape, achieving that the entire island was declared in 2000 a UNESCO World Biosphere Reserve and Geopark in 2015. Finally, we expose the 2021 eruption of La Palma island.[ES] A través de una colección de diez paneles se explica la historia geológica de la isla de El Hierro y la erupción de 2021 en la isla de La Palma. Se contextualiza cómo se formaron y evolucionaron las Islas Canarias y se introduce el nacimiento de El Hierro. A continuación, se observan los paisajes herreños como respuesta a fenómenos de macroescala, como los deslizamientos gigantes y las dorsales (rifts), y microescala (conos, lavas e islas bajas). Se expone la última erupción de la isla que dio lugar al volcán submarino Tagoro. Se presenta cómo los herreños se han adaptado al territorio, sabiendo aprovechar sus escasos recursos hídricos y adaptando su modo de vida al paisaje volcánico que le rodea, consiguiendo que la isla al completo haya sido declarada por la UNESCO Reserva Mundial de la Biosfera en el año 2000 y Geoparque en el año 2015. Finalmente, se expone la erupción de 2021 en la vecina isla de La Palma.Project LAJIAL (ref. PGC2018-101027-B-I00, MCIU/AEI/FEDER, EU). Research Consolidated Groups GEOVOL (Canary Islands Government, ULPGC) and GEOPAM (Generalitat de Catalunya, 2017 SGR 1494).dc.description.tableofcontents: Filename 01: Panel01-VolcanesMovimiento-AEPECT.pdf; Filename 02: Panel02-VolcanesMovimiento-AEPECT.pdf; Filename 03: Panel03-VolcanesMovimiento-AEPECT.pdf; Filename 04: Panel04-VolcanesMovimiento-AEPECT,pdf; Filename 05: Panel05-VolcanesMovimiento-AEPECT.pdf; Filename 06: Panel06-VolcanesMovimiento-AEPECT.pdf; Filename 07: Panel07-VolcanesMovimiento-AEPECT.pdf; Filename 08: Panel08-VolcanesMovimiento-AEPECT.pdf; Filename 09: Panel09-VolcanesMovimiento-AEPECT.pdf; Filename 10: Panel10-VolcanesMovimiento-AEPECT.pdfN

Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the LUNG SAFE database

Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p &lt; 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p &lt; 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Compilación de Proyectos de Investigacion de 1984-2002

Instituto Politecnico Nacional. UPIICS

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p &lt; 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p &lt; 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p &lt; 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease

Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients

Background: The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied. Methods: Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2: 1). Results: Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days). Conclusion: Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding