Fluid resuscitation is a core component of emergency and critical care medicine. While the focus of clinicians has largely been on detecting patients who would respond to fluid therapy, relatively ...little work has been done on assessing patients' tolerance to this therapy. In this article we seek to review the concept of fluid tolerance, propose a working definition, and introduce relevant clinical signals by which physicians can assess fluid tolerance, hopefully becoming a starting point for further research.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Building stock growth around the world drives extensive material consumption and environmental impacts. Future impacts will be dependent on the level and rate of socioeconomic development, along with ...material use and supply strategies. Here we evaluate material-related greenhouse gas (GHG) emissions for residential and commercial buildings along with their reduction potentials in 26 global regions by 2060. For a middle-of-the-road baseline scenario, building material-related emissions see an increase of 3.5 to 4.6 Gt CO2eq yr-1 between 2020-2060. Low- and lower-middle-income regions see rapid emission increase from 750 Mt (22% globally) in 2020 and 2.4 Gt (51%) in 2060, while higher-income regions shrink in both absolute and relative terms. Implementing several material efficiency strategies together in a High Efficiency (HE) scenario could almost half the baseline emissions. Yet, even in this scenario, the building material sector would require double its current proportional share of emissions to meet a 1.5 °C-compatible target.
To determine whether time-to-intubation was associated with higher ICU mortality in patients with COVID-19 on mechanical ventilation due to respiratory insufficiency.
We conducted an observational, ...prospective, single-center study of patients with confirmed SARS-CoV-2 infection hospitalized with moderate to severe ARDS, connected to mechanical ventilation in the ICU between March 17 and July 31, 2020. We examined their general and clinical characteristics. Time-to-intubation was the time from hospital admission to endotracheal intubation.
We included 183 consecutive patients; 28% were female, and median age was 62 years old. Eighty-eight patients (48%) were intubated before 48 h (early) and ninety-five (52%) after 48 h (late). Patients intubated early had similar admission PaO2/FiO2 ratio (123 vs 99; p = 0.179) but were younger (59 vs 64; p = 0.013) and had higher body mass index (30 vs 28; p = 0.006) compared to patients intubated late. Mortality was higher in patients intubated late (18% versus 43%), with admission PaO2/FiO2 ratio < 100 mmHg (OR 5.2; p = 0.011), of older age (OR 1.1; p = 0.001), and with previous use of ACE inhibitors (OR 4.8; p = 0.026).
In COVID-19 patients, late intubation, Pafi <100, older age, and previous ACE inhibitors use were associated with increased ICU mortality.
•Time to intubation maybe associated with an increase in mortality in hypoxemic COVID-19 patients.•COVID-19 patients > 60 years-old, admitted with PaO2FiO2 ratio < 100 may have higher ICU mortality when intubated after 48 h.•Patients admitted with PaO2FiO2 ratio < 100 intubated > 48 h have worse lung mechanics than similar patients intubated < 48 h.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
•Pycirk, a python package to create complex scenarios using the mrEEIOA database EXIOBASE (https://pypi.org/project/pycirk/).•Methods and blueprints to increase transparency of modeling assumptions ...for the Circular Economy.•A case study on two circular economy strategies - Product Life Extension and Resource Efficiency.
A circular economy is an industrial system that is restorative or regenerative by intention or design. During the last decade, the circular economy became an attractive paradigm to increase global welfare while minimizing the environmental impacts of economic activities. Although several studies concerning the potential benefits and drawbacks of policies that implement the new paradigm have been performed, there is currently no standardized theoretical model or software to execute such assessment. In order to fill this gap, in the present paper we show how to perform these analyses using Environmentally Extended Input-Output Analysis. We also describe a python package (pycirk) for modeling Circular Economy scenarios in the context of the Environmentally Extended Multi-Regional Input-Output database EXIOBASE V3.3, for the year 2011. We exemplify the methods and software through a what-if zero-cost case study on two circular economy strategies (Resource Efficiency and Product Lifetime Extension), four environmental pressures and two socio-economic factors.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Microcirculatory alterations play a major role in the pathogenesis of shock. Monitoring tissue perfusion might be a relevant goal for shock resuscitation. The goal of this review was to revise the ...evidence supporting the monitoring of peripheral perfusion and microcirculation as goals of resuscitation. For this purpose, we mainly focused on skin perfusion and sublingual microcirculation.
Although there are controversies about the reproducibility of capillary refill time in monitoring peripheral perfusion, it is a sound physiological variable and suitable for the ICU settings. In addition, observational studies showed its strong ability to predict outcome. Moreover, a preliminary study suggested that it might be a valuable goal for resuscitation. These results should be confirmed by the ongoing ANDROMEDA-SHOCK randomized controlled trial. On the other hand, the monitoring of sublingual microcirculation might also provide relevant physiological and prognostic information. On the contrary, methodological drawbacks mainly related to video assessment hamper its clinical implementation at the present time.
Measurements of peripheral perfusion might be useful as goal of resuscitation. The results of the ANDROMEDA-SHOCK will clarify the role of skin perfusion as a guide for the treatment of shock. In contrast, the assessment of sublingual microcirculation mainly remains as a research tool.
This study retrospectively examined the hemodynamic effects of passive leg raising (PLR) in mechanically ventilated patients during fluid removal before spontaneous breathing trials. In previous ...studies, we noticed varying cardiac responses after PLR completion, particularly in positive tests. Using a bioreactance monitor, we recorded and analyzed hemodynamic parameters, including stroke volume and cardiac index (CI), before and after PLR in post-acute ICU patients. We included 27 patients who underwent 60 PLR procedures. In preload-unresponsive patients, no significant CI changes were observed (CI_t-6 = 3.7 2.6; 4.7 mL/min/m2 vs. CI_t9 = 3.3 2.5; 3.4 mL/min/m2; p = 0.306), while in preload-responsive patients, two distinct CI response types to PLR were identified: a transient peak with immediate return to baseline (CI_t-6 = 2.7 2.5; 3.1 mL/min/m2 vs. 3.3 2.6; 3.8 L/min/m2; p = 0.119) and a sustained CI elevation lasting beyond the PLR maneuver (CI_t-6 = 2.8 2.3; 2.9 L/min/m2 vs. 3.3 2.8; 3.9 ml/min/m2; p = 0.034). The latter was particularly noted when ΔCI during PLR exceeded 25%. Our findings suggest that in certain preload-responsive patients, PLR can induce a more sustained increase in CI, indicating a possible persistent hemodynamic effect. This effect could be due to a combination of autotransfusion and sympathetic activation affecting venous return and vascular tone. Further research in larger cohorts and more comprehensive hemodynamic assessments are warranted to validate these observations and elucidate the possible underlying mechanisms.The Fluid unLoading On Weaning (FLOW) study was prospectively registered under the ID NCT04496583 on 2020-07-29 at ClinicalTrials.gov.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Based on these data and our previous unpublished local experience for a decade, we decided to use NS due to its more favorable distribution, as it is widely known that administration of 5% dextrose ...impacts mainly the intracellular compartment, with negligible effect on intravascular when compared to NS, even in cases when capillary integrity is present 6. Randomized controlled trial Ibarra-Estrada M, Kattan E, Aguilera-González P, Sandoval-Plascencia L, Rico-Jauregui U, Gómez-Partida CA, et al. Early adjunctive methylene blue in patients with septic shock: a randomized controlled trial.
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