Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Study of the NOx Selective Catalytic Reduction (SCR) by an ethanol-ammonia mixture

La Réduction Catalytique Sélective des NOx par NH3 est un procédé efficace de dépollution des gaz. Cependant, pour une application sur véhicules Diesel, l'activité à basse température (175-250°C, phase de démarrage du véhicule) reste limitée. De plus, les catalyseurs de NH3-SCR sont sensibles au rapport NO2/NOx, avec un optimum pour NO2/NOx = 0,5. Or, à basse température, la proportion de NO2 est faible car le catalyseur d’oxydation (DOC) placé en amont est également peu actif. L'éthanol (EtOH) est un autre réducteur possible, principalement avec des catalyseurs Ag/Al2O3. Ce système présente également d'une activité limitée à basse température, bien que l'oxydation de EtOH s'accompagne de la formation de NO2. Dans ces travaux, l'association de EtOH et NH3 pour la SCR de NO sur catalyseur Ag/Al2O3 a été étudié. Un effet de synergie a été obtenu, avec un gain important d'activité à basse température. Ce gain ne provient pas directement d'une réaction entre NH3 et EtOH ou ses sous-produits d'oxydation (CH3CHO, CO…), ni uniquement grâce à la réaction entre NO2 (formé par réaction de NO avec EtOH) et NH3. La caractérisation des espèces adsorbées par IRTF et des tests de (H2+NH3)-SCR ont permis de conclure que les espèces H*, provenant de la déshydrogénation de l'éthanol, réagissent avec les NOx pour conduire à des espèces HNOx très réactives avec NH3.Finalement, la mise en œuvre d'un double-lit (2%Ag/Al2O3 + catalyseur de NH3-SCR), afin d'utiliser NH3, NO et NO2 restants, a permis d'obtenir une conversion NOx comprise entre 46 et 95% entre 175 et 250°C. Ce système permet donc une conversion des NOx élevée à basse température en s'affranchissant du NO2 procuré par le DOC.The NOx Selective Catalytic Reduction is an efficient process for exhaust gas treatment. However, for Diesel vehicles, the activity at low temperature (175-250°C, starting phase of vehicles) remains limited. In addition, the NH3-SCR catalysts are sensitive to the NO2/NOx ratio, with an optimum for NO2/NOx = 0.5. Unfortunately, at low temperature, the proportion of NO2 is low because the oxidation catalyst (DOC) placed upstream is also weakly efficient.Ethanol (EtOH) is another possible reductant, mainly associated with Ag/Al2O3 catalysts. This system also has a limited activity at low temperature, although the oxidation of EtOH is accompanied by NO2 formation. In this work, the association of EtOH and NH3 for the SCR of NO on a Ag/Al2O3 catalyst was studied. A synergistic effect was obtained, with a high gain of conversion at low temperature. This gain neither results from a reaction between NH3 and EtOH or its oxidation by-products (CH3CHO, CO…), nor only by the reaction between NO2 (formed by reaction of NO with EtOH) and NH3. Characterization of adsorbed species by FTIR and (H2+NH3)-SCR experiments led to the conclusion that H* species, resulting from ethanol dehydrogenation, react with NOx to yield HNOx species highly reactive with NH3.Finally, in order to use the remaining NH3, NO and NO2, the use of a dual bed (2%Ag/Al2O3 + NH3-SCR catalyst) allowed a NOx conversion between 46 and 95% from 175 to 250°C. This system consequently allows a high NOx conversion at low temperature, avoiding the NO2 lack at low temperature (low DOC activity)

Étude de la réduction catalytique sélective (SCR) des NOx par un mélange éthanol-ammoniac

The NOx Selective Catalytic Reduction is an efficient process for exhaust gas treatment. However, for Diesel vehicles, the activity at low temperature (175-250°C, starting phase of vehicles) remains limited. In addition, the NH3-SCR catalysts are sensitive to the NO2/NOx ratio, with an optimum for NO2/NOx = 0.5. Unfortunately, at low temperature, the proportion of NO2 is low because the oxidation catalyst (DOC) placed upstream is also weakly efficient.Ethanol (EtOH) is another possible reductant, mainly associated with Ag/Al2O3 catalysts. This system also has a limited activity at low temperature, although the oxidation of EtOH is accompanied by NO2 formation. In this work, the association of EtOH and NH3 for the SCR of NO on a Ag/Al2O3 catalyst was studied. A synergistic effect was obtained, with a high gain of conversion at low temperature. This gain neither results from a reaction between NH3 and EtOH or its oxidation by-products (CH3CHO, CO…), nor only by the reaction between NO2 (formed by reaction of NO with EtOH) and NH3. Characterization of adsorbed species by FTIR and (H2+NH3)-SCR experiments led to the conclusion that H* species, resulting from ethanol dehydrogenation, react with NOx to yield HNOx species highly reactive with NH3.Finally, in order to use the remaining NH3, NO and NO2, the use of a dual bed (2%Ag/Al2O3 + NH3-SCR catalyst) allowed a NOx conversion between 46 and 95% from 175 to 250°C. This system consequently allows a high NOx conversion at low temperature, avoiding the NO2 lack at low temperature (low DOC activity).La Réduction Catalytique Sélective des NOx par NH3 est un procédé efficace de dépollution des gaz. Cependant, pour une application sur véhicules Diesel, l'activité à basse température (175-250°C, phase de démarrage du véhicule) reste limitée. De plus, les catalyseurs de NH3-SCR sont sensibles au rapport NO2/NOx, avec un optimum pour NO2/NOx = 0,5. Or, à basse température, la proportion de NO2 est faible car le catalyseur d’oxydation (DOC) placé en amont est également peu actif. L'éthanol (EtOH) est un autre réducteur possible, principalement avec des catalyseurs Ag/Al2O3. Ce système présente également d'une activité limitée à basse température, bien que l'oxydation de EtOH s'accompagne de la formation de NO2. Dans ces travaux, l'association de EtOH et NH3 pour la SCR de NO sur catalyseur Ag/Al2O3 a été étudié. Un effet de synergie a été obtenu, avec un gain important d'activité à basse température. Ce gain ne provient pas directement d'une réaction entre NH3 et EtOH ou ses sous-produits d'oxydation (CH3CHO, CO…), ni uniquement grâce à la réaction entre NO2 (formé par réaction de NO avec EtOH) et NH3. La caractérisation des espèces adsorbées par IRTF et des tests de (H2+NH3)-SCR ont permis de conclure que les espèces H*, provenant de la déshydrogénation de l'éthanol, réagissent avec les NOx pour conduire à des espèces HNOx très réactives avec NH3.Finalement, la mise en œuvre d'un double-lit (2%Ag/Al2O3 + catalyseur de NH3-SCR), afin d'utiliser NH3, NO et NO2 restants, a permis d'obtenir une conversion NOx comprise entre 46 et 95% entre 175 et 250°C. Ce système permet donc une conversion des NOx élevée à basse température en s'affranchissant du NO2 procuré par le DOC

Bi-functional synergy of (EtOH+NH3) reducing agents for NOx removal in lean media: Effect of catalytic dual-bed configuration

International audienc

Selective catalytic reduction of NO at low temperature using a (ethanol+ammonia) mixture over a Ag/Al2O3 + WO3/Cex-ZryO2 dual-bed catalytic system: Reactivity insight of WO3/Cex-ZryO2

International audienc

(EtOH+NH3) synergism in lean-NOx reduction over Ag/Al2O3 catalyst

International audienceThe implemented Urea-SCR technology is an effective process for NOx reduction from Diesel vehicles but is strongly dependent at low temperature (175-250°C) to the NO2/NOx ratio. By means of co-feeding of ammonia and ethanol over Ag/Al2O3 catalyst, a drastic enhancement of the NOx conversion is evidenced using only NO as NOx. The ammonia activation is mainly attributed to the availability of hydrogen H* species resulting from EtOH oxidation. A remarkable DeNOx efficiency is additionally achieved with a dual-bed configuration (Ag/Al2O3+NH3-SCR catalyst) leading to impressive performances of this EtOH-assisted process without critical dependence to the NO2 yield

Remarkable enhancement of the deNOx efficiency at low temperature: collaborative effect of ethanol and NH3 for the NO Selective Catalytic Reduction

International audienceThe NOx selective catalytic reduction (SCR) is extensively studied as an effective process for air pollutants abatement from lean burn and Diesel vehicles. In the implemented Urea-SCR technology, the NO2/NOx ratio is a key parameter that limits the deNOx efficiency at low temperature (175-250°C). We demonstrate that co-feeding of ammonia and ethanol on a Ag/Al2O3 catalyst enables a drastic enhancement of the NOx conversion using only NO as NOx (standard SCR condition). The ammonia activation is not attributed to a direct reaction with NO but both to the presence of NO2 provided by the NO oxidation with EtOH, and the availability of hydrogen H* species resulting from EtOH oxidation. In order to improve the use of the injected ammonia, this EtOH-assisted process was experimented with a dual-bed configuration (Ag/Al2O3+NH3-SCR catalyst). It allowed a remarkable supplementary enhancement of the NOx conversion in the 175-250°C temperature range in the unfavorable standard SCR condition

Urea vs NH3 in NOx selective catalytic reduction at laboratory scale

International audienc

Surface oxidation of Ni-cermet electrodes by CO2 and H2O and how to moderate it

International audienceThe oxidation of porous Ni-yttria-stabilized zirconia (YSZ) and Ni-gadolinia-doped ceria (GDC) ceramic-metal (cermet) electrodes in H2O and CO2 atmospheres was studied by near-ambient pressure X-ray photoelectron spectroscopy (NAP-XPS). We show that the oxidation of nickel by the two gases is not similar, as is commonly believed, but it depends on the ceramic type. Nickel is vulnerable to oxidation in H2O but it resists to CO2 in Ni-GDC, as compared to the Ni-YSZ electrode. Inspired by this observation we conceptualize and fabricate Ni-YSZ electrodes modified by ceria nanoparticles, which show significantly higher resistance to CO2 oxidation as compared with conventional Ni-YSZ electrodes. The preparation of tailor-made cermet electrodes with identical bulk/mechanical characteristics but very different surface properties offers a promising fabrication strategy for high-performance and durability solid oxide electrolysis cells for CO2 conversion

Influence of the Sodium Impregnation Solvent on the Deactivation of Cu/FER-Exchanged Zeolites Dedicated to the SCR of NOx with NH3

The effect of the sodium addition mode was investigated on model Cu/FER selective catalytic reduction (SCR) catalysts with two copper loadings (2.8 wt. % and 6.1 wt. %) in order to compare samples with or without over-exchanged copper. Na was added by wet-impregnation using two solvents: water or ethanol. Catalysts were evaluated in Standard and Fast-SCR conditions, as well as in NO and NH3 oxidation. They were characterized by H2-TPR, NO and NH3 adsorption monitored by FT-IR. As expected, whatever the copper loading, ammonia adsorption capacity was decreased by Na additions. Interestingly, characterizations also showed that Na impregnation in water favors the migration of the Cu-exchanged species, leading to the formation of CuO extra-framework compounds. Consequently, for both copper loadings, Na impregnation in water led to a stronger catalyst deactivation than impregnation in ethanol. Finally, the NOx conversion at low temperature (250 °C) appeared mainly affected by the loss in NH3 adsorption capacity whereas the deNOx deactivation at high temperature (500 °C) was rather governed by the decrease in the exchanged copper ratio, which also induced a partial inhibition of NO and NH3 oxidation behaviors