Sepsis remains a common condition with high mortality when multiple organ failure develops. The evidence for therapeutic plasma exchange (TPE) in this setting is promising but inconclusive. Our study ...aims to evaluate the efficacy of adjunct TPE for septic shock with multiple organ failure compared to standard therapy alone.
A retrospective, observational chart review was performed, evaluating outcomes of patients with catecholamine-resistant septic shock and multiple organ failure in intensive care units at a tertiary care hospital in Winston-Salem, NC, from August 2015 to March 2019. Adult patients with catecholamine-resistant septic shock (≥ 2 vasopressors) and evidence of multiple organ failure were included. Patients who received adjunct TPE were identified and compared to patients who received standard care alone. A propensity score using age, gender, chronic co-morbidities (HTN, DM, CKD, COPD), APACHE II score, SOFA score, lactate level, and number of vasopressors was used to match patients, resulting in 40 patients in each arm.
The mean baseline APACHE II and SOFA scores were 32.5 and 14.3 in TPE patients versus 32.7 and 13.8 in control patients, respectively. The 28-day mortality rate was 40% in the TPE group versus 65% in the standard care group (p = 0.043). Improvements in baseline SOFA scores at 48 h were greater in the TPE group compared to standard care alone (p = 0.001), and patients receiving adjunct TPE had a more favorable fluid balance at 48 h (p = 0.01). Patients receiving adjunct TPE had longer ICU and hospital lengths of stay (p = 0.003 and p = 0.006, respectively).
Our retrospective, observational study in adult patients with septic shock and multiple organ failure demonstrated improved 28-day survival with adjunct TPE compared to standard care alone. Hemodynamics, organ dysfunction, and fluid balance all improved with adjunct TPE, while lengths of stay were increased in survivors. The study design does not allow for a generalized statement of support for TPE in all cases of sepsis with multiple organ failure but offers valuable information for a prospective, randomized clinical trial.
SCISAT‐1, also known as the Atmospheric Chemistry Experiment (ACE), is a Canadian satellite mission for remote sensing of the Earth's atmosphere. It was launched into low Earth circular orbit ...(altitude 650 km, inclination 74°) on 12 Aug. 2003. The primary ACE instrument is a high spectral resolution (0.02 cm−1) Fourier Transform Spectrometer (FTS) operating from 2.2 to 13.3 μm (750–4400 cm−1). The satellite also features a dual spectrophotometer known as MAESTRO with wavelength coverage of 285–1030 nm and spectral resolution of 1–2 nm. A pair of filtered CMOS detector arrays records images of the Sun at 0.525 and 1.02 μm. Working primarily in solar occultation, the satellite provides altitude profile information (typically 10–100 km) for temperature, pressure, and the volume mixing ratios for several dozen molecules of atmospheric interest, as well as atmospheric extinction profiles over the latitudes 85°N to 85°S. This paper presents a mission overview and some of the first scientific results.
The Arctic polar vortex exhibited widespread regions of low temperatures during the winter of 2005, resulting in significant ozone depletion by chlorine and bromine species. We show that chemical ...loss of column ozone (ΔO3) and the volume of Arctic vortex air cold enough to support the existence of polar stratospheric clouds (VPSC) both exceed levels found for any other Arctic winter during the past 40 years. Cold conditions and ozone loss in the lowermost Arctic stratosphere (e.g., between potential temperatures of 360 to 400 K) were particularly unusual compared to previous years. Measurements indicate ΔO3 = 121 ± 20 DU and that ΔO3 versus VPSC lies along an extension of the compact, near linear relation observed for previous Arctic winters. The maximum value of VPSC during five to ten year intervals exhibits a steady, monotonic increase over the past four decades, indicating that the coldest Arctic winters have become significantly colder, and hence are more conducive to ozone depletion by anthropogenic halogens.
Time series of total column abundances of hydrogen chloride (HCl), chlorine nitrate (ClONO2 ), and hydrogen fluoride (HF) were determined from ground-based Fourier transform infrared (FTIR) spectra ...recorded at 17 sites belonging to the Network for the Detection of Atmospheric Composition Change (NDACC) and located between 80.05° N and 77.82° S. By providing such a near-global overview on ground-based measurements of the two major stratospheric chlorine reservoir species, HCl and ClONO2 , the present study is able to confirm the decrease of the atmospheric inorganic chlorine abundance during the last few years. This decrease is expected following the 1987 Montreal Protocol and its amendments and adjustments, where restrictions and a subsequent phase-out of the prominent anthropogenic chlorine source gases (solvents, chlorofluorocarbons) were agreed upon to enable a stabilisation and recovery of the stratospheric ozone layer. The atmospheric fluorine content is expected to be influenced by the Montreal Protocol, too, because most of the banned anthropogenic gases also represent important fluorine sources. But many of the substitutes to the banned gases also contain fluorine so that the HF total column abundance is expected to have continued to increase during the last few years. The measurements are compared with calculations from five different models: the two-dimensional Bremen model, the two chemistry-transport models KASIMA and SLIMCAT, and the two chemistry-climate models EMAC and SOCOL. Thereby, the ability of the models to reproduce the absolute total column amounts, the seasonal cycles, and the temporal evolution found in the FTIR measurements is investigated and inter-compared. This is especially interesting because the models have different architectures. The overall agreement between the measurements and models for the total column abundances and the seasonal cycles is good. Linear trends of HCl, ClONO2 , and HF are calculated from both measurement and model time series data, with a focus on the time range 2000-2009. This period is chosen because from most of the measurement sites taking part in this study, data are available during these years. The precision of the trends is estimated with the bootstrap resampling method. The sensitivity of the trend results with respect to the fitting function, the time of year chosen and time series length is investigated, as well as a bias due to the irregular sampling of the measurements. The measurements and model results investigated here agree qualitatively on a decrease of the chlorine species by around 1% yr-1 . The models simulate an increase of HF of around 1% yr-1 . This also agrees well with most of the measurements, but some of the FTIR series in the Northern Hemisphere show a stabilisation or even a decrease in the last few years. In general, for all three gases, the measured trends vary more strongly with latitude and hemisphere than the modelled trends. Relative to the FTIR measurements, the models tend to underestimate the decreasing chlorine trends and to overestimate the fluorine increase in the Northern Hemisphere. At most sites, the models simulate a stronger decrease of ClONO2 than of HCl. In the FTIR measurements, this difference between the trends of HCl and ClONO2 depends strongly on latitude, especially in the Northern Hemisphere.
As a consequence of dynamically variable meteorological conditions, springtime Arctic ozone levels exhibit significant interannual variability in the lower stratosphere. In winter 2011, the polar ...vortex was strong and cold for an unusually long time. Our research site, located at Eureka, Nunavut, Canada (80.05° N, 86.42° W), was mostly inside the vortex from October 2010 until late March 2011. The Bruker 125HR Fourier transform infrared spectrometer installed at the Polar Environment Atmospheric Research Laboratory at Eureka acquired measurements from 23 February to 6 April during the 2011 Canadian Arctic Atmospheric Chemistry Experiment Validation Campaign. These measurements showed unusually low ozone, HCl, and HNO3 total columns compared to the previous 14 yr. To remove dynamical effects, we normalized these total columns by the HF total column. The normalized values of the ozone, HCl, and HNO3 total columns were smaller than those from previous years, and confirmed the occurrence of chlorine activation and chemical ozone depletion. To quantify the chemical ozone loss, a three-dimensional chemical transport model, SLIMCAT, and the passive subtraction method were used. The chemical ozone depletion was calculated as the mean percentage difference between the measured ozone and the SLIMCAT passive ozone, and was found to be 35%.
Time series of total column abundances of hydrogen chloride (HCl), chlorine nitrate (ClONO2), and hydrogen fluoride (HF) were determined from ground-based Fourier transform infrared (FTIR) spectra ...recorded at 17 sites belonging to the Network for the Detection of Atmospheric Composition Change (NDACC) and located between 80.05° N and 77.82° S. By providing such a near-global overview on ground-based measurements of the two major stratospheric chlorine reservoir species, HCl and ClONO2, the present study is able to confirm the decrease of the atmospheric inorganic chlorine abundance during the last few years. This decrease is expected following the 1987 Montreal Protocol and its amendments and adjustments, where restrictions and a subsequent phase-out of the prominent anthropogenic chlorine source gases (solvents, chlorofluorocarbons) were agreed upon to enable a stabilisation and recovery of the stratospheric ozone layer. The atmospheric fluorine content is expected to be influenced by the Montreal Protocol, too, because most of the banned anthropogenic gases also represent important fluorine sources. But many of the substitutes to the banned gases also contain fluorine so that the HF total column abundance is expected to have continued to increase during the last few years. The measurements are compared with calculations from five different models: the two-dimensional Bremen model, the two chemistry-transport models KASIMA and SLIMCAT, and the two chemistry-climate models EMAC and SOCOL. Thereby, the ability of the models to reproduce the absolute total column amounts, the seasonal cycles, and the temporal evolution found in the FTIR measurements is investigated and inter-compared. This is especially interesting because the models have different architectures. The overall agreement between the measurements and models for the total column abundances and the seasonal cycles is good. Linear trends of HCl, ClONO2, and HF are calculated from both measurement and model time series data, with a focus on the time range 2000–2009. This period is chosen because from most of the measurement sites taking part in this study, data are available during these years. The precision of the trends is estimated with the bootstrap resampling method. The sensitivity of the trend results with respect to the fitting function, the time of year chosen and time series length is investigated, as well as a bias due to the irregular sampling of the measurements. The measurements and model results investigated here agree qualitatively on a decrease of the chlorine species by around 1% yr−1. The models simulate an increase of HF of around 1% yr−1. This also agrees well with most of the measurements, but some of the FTIR series in the Northern Hemisphere show a stabilisation or even a decrease in the last few years. In general, for all three gases, the measured trends vary more strongly with latitude and hemisphere than the modelled trends. Relative to the FTIR measurements, the models tend to underestimate the decreasing chlorine trends and to overestimate the fluorine increase in the Northern Hemisphere. At most sites, the models simulate a stronger decrease of ClONO2 than of HCl. In the FTIR measurements, this difference between the trends of HCl and ClONO2 depends strongly on latitude, especially in the Northern Hemisphere.
During Arctic winters with a cold, stable stratospheric circulation, reactions on the surface of polar stratospheric clouds (PSCs) lead to elevated abundances of chlorine monoxide (ClO) that, in the ...presence of sunlight, destroy ozone. Here we show that PSCs were more widespread during the 1999/2000 Arctic winter than for any other Arctic winter in the past two decades. We have used three fundamentally different approaches to derive the degree of chemical ozone loss from ozonesonde, balloon, aircraft, and satellite instruments. We show that the ozone losses derived from these different instruments and approaches agree very well, resulting in a high level of confidence in the results. Chemical processes led to a 70% reduction of ozone for a region ∼1 km thick of the lower stratosphere, the largest degree of local loss ever reported for the Arctic. The Match analysis of ozonesonde data shows that the accumulated chemical loss of ozone inside the Arctic vortex totaled 117 ± 14 Dobson units (DU) by the end of winter. This loss, combined with dynamical redistribution of air parcels, resulted in a 88 ± 13 DU reduction in total column ozone compared to the amount that would have been present in the absence of any chemical loss. The chemical loss of ozone throughout the winter was nearly balanced by dynamical resupply of ozone to the vortex, resulting in a relatively constant value of total ozone of 340 ± 50 DU between early January and late March. This observation of nearly constant total ozone in the Arctic vortex is in contrast to the increase of total column ozone between January and March that is observed during most years.
The 2006 Canadian Arctic ACE (Atmospheric Chemistry Experiment) Validation Campaign collected measurements at the Polar Environment Atmospheric Research Laboratory (PEARL, 86.42° W, 80.05° N, 610 m ...a.s.l.) at Eureka, Canada from 17 February to 31 March 2006. Two of the ten instruments involved in the campaign, both Fourier transform spectrometers (FTSs), were operated simultaneously, recording atmospheric solar absorption spectra. The first instrument was an ABB Bomem DA8 high-resolution infrared FTS. The second instrument was the Portable Atmospheric Research Interferometric Spectrometer for the Infrared (PARIS-IR), the ground-based version of the satellite-borne FTS on the ACE satellite (ACE-FTS). From the measurements collected by these two ground-based instruments, total column densities of seven stratospheric trace gases (O3, HCl, ClONO2, HF, HNO3, NO2, and NO) were retrieved using the optimal estimation method and these results were compared. Since the two instruments sampled the same portions of atmosphere by synchronizing observations during the campaign and used consistent retrieval parameters, the biases in retrieved columns from the two spectrometers represent the instrumental differences. Mean differences in total column densities of O3, HCl, ClONO2, HF, HNO3, and NO2 from the observations between PARIS-IR and the DA8 FTS are 2.8 %, −3.2 %, −4.3 %, −1.5 %, −1.9 %, and −0.1 %, respectively. Partial column results from the ground-based spectrometers were also compared with partial columns derived from ACE-FTS version 2.2 (including updates for O3) profiles. Mean differences in partial column densities of O3, HCl, ClONO2, HF, HNO3, NO2, and NO from the measurements between ACE-FTS and the DA8 FTS are −5.9 %, −8.5 %, −11.8 %, −0.9 %, −6.6 %, −21.6 % and −7.6 % respectively. Mean differences in partial column densities of O3, HCl, ClONO2, HF, HNO3, NO2 from the measurements between ACE-FTS and the PARIS-IR are −5.2 %, −4.6 %, −2.3 %, −4.7 %, 5.7 % and −11.9 %, respectively. This work provides further evidence of the reliability of ACE-FTS measurements from the first three years of on-orbit observations. Column densities of O3, HCl, ClONO2, and HNO3 from the three FTSs were normalized with respect to HF and used to compare the time evolution of the chemical constituents in the atmosphere over Eureka during spring 2006.
This paper presents a long-term set of total column densities of N
2
O, CH
4
, HF, COF
2
, HCl, ClONO
2
, O
3
, NO, NO
2
and HNO
3
, measured with an ABB Bomem DA8 Fourier transform infrared (FTIR) ...spectrometer and a consistent methodology, during fall and spring at Eureka (80°N), Nunavut, Canada. The instrumentation, observations and retrievals of the column densities from infrared atmospheric solar absorption spectra are described in detail, including an estimate of the uncertainties in our retrieved column densities. This description also applies to the column data that we have archived on the Data Host Facility of the Network for the Detection of Atmospheric Composition Change (NDACC). The work presented here serves as an introduction to the entire dataset of atmospheric spectra recorded with the DA8 spectrometer at Eureka from 1993 to 2008. A few highlights from the results of our column retrievals for the years 1997 to 2006 are briefly discussed. One of these is the exceptionally low O
3
, HCl and HNO
3
column amounts observed in the spring of 1997 which we ascribe to uptake of gaseous HNO
3
on aerosols of type Ib Polar Stratospheric Clouds (PSCs), resulting in appreciable chlorine activation with subsequent chemical ozone depletion. Another is the anomalously high NO columns measured throughout the month of March 2004, the only time this was observed in our ten-year record presented here. We attribute this to the meso-thermospheric contribution by enhanced solar activity. Some comparisons with Ny Alesund observations at 79°N are also discussed.
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